Far Eastern University

Institute of Nursing
S.Y. 2018-2019 2nd Semester

PERFORMANCE EVALUATION TOOL

Name: ___________________________ Date: __________

NUMERICAL RATING QUANTITATIVE DESCRIPTION

3 Outstanding Carries out expected tasks in
a very consistent manner with
minimal guidelines and
supervision
2 Satisfactory Carries out expected tasks in
a consistent manner with
minimal guidelines and
supervision
1 Needs improvement Carries out expected tasks in
a rarely consistent manner
with minimal guidelines and
supervision
0 Unsatisfactory Does not carry out expected
tasks even with close
guidance and supervision

Performance 3 2 1 0 REMARKS
I. ASSESSMENT
1. Establishes rapport with patient, significant
others, and members of the team
2. Demonstrates therapeutic communication skills
during patient care and identify and interpret
verbal and non-verbal cues
3. Utilizes effective communication skills relevant
to patient care.
4. Gathers comprehensive nursing health history
5. Performs appropriate physical assessment
techniques
6. Identifies and analyzes the priority need of
patients
7. Determines appropriate nursing care to address
needs and problems
8. Explain interventions to patients and family
before implementation
II. IMPLEMENTATION
1. Performs effective nursing activities within the
time frame.
2. Implements appropriate nursing intervention that
is safe and comfortable.
3. Monitors effectiveness of nursing interventions.
4. Follows the 10 golden rules in medication
administration.
5. Device appropriate strategy in conducting health
teaching.
6. Provides appropriate and comprehensive teaching
regarding the topic chosen.
 Far Eastern University
Institute of Nursing
S.Y. 2018-2019 2nd Semester

III. EVALUATION
1. Evaluates the expected outcomes of the
interventions made.
2. Reports significant changes in patient’s condition.
3. Gives an accurate report on observations from
patients.
IV. ETHICO-LEGAL CONSIDERATION
1. Acts according to the rules and regulations of the
healthcare unit.
2. Accomplishes accurate documentation in all
matters according to the standards of the
healthcare unit.
3. Provides nursing care according to patient’s Bill
of Rights.
4. Understands the responsibility and accountability
based on the nursing actions done.
5. Keeps the confidential information of the
patients.
6. Observe ethico-moral in legal standard of nursing
practice at all times.
7. Show appreciation of the FEU core values;
Fortitude, Excellence, and Uprightness in relation
to all nursing activities.

Total score / 72 x 100 = ____________

___________________________ ____________________________
Signature of student staff nurse Signature of Student Head Nurse

____________________________
Signature of Clinical Instructor