HOLY NAME UNIVERSITY

College of Health Sciences

Bachelor of Science in Nursing
Tagbilaran City, Bohol

Performance Evaluation Rating Sheet

Name: Level: Date of Assignment:

Clinical Area:

Assessment Criteria: Excellent (4) Proficient (3) Developing (2) Need Improvement (1) Score
(Performance Indicators)

1. Assessed clients with life- The learner demonstrates exceptional The learner accurately The learner performs basic The learner fails to
threatening conditions, ability in assessing clients with critical assesses clients and assessments but may complete or delays
acutely ill / multi-organ conditions. Data collection is thorough, recognizes critical signs overlook critical assessments.
problems, high acuity, and systematic, and prioritized. Recognizes with minimal guidance. important signs or data. Often overlooks urgent
emergencies. and responds promptly to life- Performs systematic Needs frequent supervision findings, misuses tools,
threatening signs. Uses clinical tools assessments and uses and prompting. Uses or requires constant
accurately and integrates findings into standard tools assessment tools direction. Lacks
effective decision-making. Requires no appropriately. inconsistently. Clinical clinical judgment in
supervision. Communicate findings judgment and urgency high-risk situations,
clearly. Demonstrates recognition are developing posing a safety
sound clinical reasoning but not yet reliable. concern for patients.
but may miss subtle
cues.
2. Formulated with the client a The learner collaboratively develops a The learner formulates The learner creates a care The learner fails to
plan of care to address the comprehensive, individualized plan of an appropriate care plan plan that addresses some develop a clear or
health conditions, needs, care with the client. Priorities are that addresses key client client needs but lacks full appropriate plan of
problems, and issues identified and based on assessment problems and priorities. prioritization or client care. Prioritization is
based on priorities. findings. The plan reflects a holistic, Works with the client to involvement. Plan may be poor or absent, and
evidence-based approach, aligns with set realistic goals. The generic or missing rationale. client input is minimal
client goals, and anticipates possible plan is generally or ignored. The plan
Requires frequent
complications. Requires no supervision. individualized, lacks coherence,
though may lack depth in supervision and revision. critical
some areas. Requires elements, or feasibility.
minimal guidance. Needs constant
guidance and
correction.
3. Implemented safe and The learner consistently implements The learner carries out The learner performs some The learner performs
quality interventions with evidence-based, safe, and effective appropriate and required interventions but interventions with
the client to address the interventions tailored to the client’s generally safe with limited consistency or significant errors or
health needs, problems, specific needs. Demonstrates interventions with attention to detail. May omissions. Fails to
and issues. confidence, precision, and adherence to minimal supervision. overlook safety ensures client safety,
best practices. Follows protocols and checks or require frequent disregards protocols, or
Anticipates potential complications and standards, engages the needs constant
reminders. Client
involves the client throughout the client, and ensures supervision. May pose
involvement is minimal or
process. Requires no supervision. quality care. May need risk to the patient or fail
inconsistent. Needs regular to address identified
occasional prompting for
guidance. health needs
refinement or efficiency.
adequately.
4. Provided health education The learner delivers well-organized, The learner provides The learner delivers basic The learner provides
using selected planning client-centered health education based appropriate health health education but lacks unclear, inappropriate,
models to the targeted on an appropriate planning model (e.g., education using a full integration of a planning or poorly
clientele PRECEDE-PROCEED, Health Belief relevant planning model. model or organized health
Model, etc.). Content is clear, culturally Content is client-centered strategies. education. No use of a
sensitive, and tailored to the needs, generally clear and Content may be too general, planning model is
literacy level, and preferences of the suited to the target unclear, or not well-adapted evident. Fails to
target group. Engages clients actively clientele. Involves clients to the audience. Needs engage the clientele or
frequent supervision. assess
 and evaluates understanding. Requires and checks for understanding.
no supervision. understanding. Requires constant
May need minimal guidance and
guidance for correction.
improvement or depth.
5. Evaluated with the client the The learner actively involves the client The learner effectively The learner completes basic The learner fails to
health status/ competence and in evaluating health status and progress evaluates client progress evaluation tasks but with evaluate outcomes
/Or process/expected outcomes toward goals. Consistently reviews the and outcomes, with limited client involvement. meaningfully or
of the nurse-client working nurse-client relationship, encourages some client involvement. Focuses more on clinical neglects to involve the
relationship. feedback, and adjusts care based on Reviews the nurse-client results than on relational or client. Shows limited
mutual evaluation. Demonstrates strong relationship and process-based evaluation. insight into the nurse-
therapeutic communication and incorporates feedback Needs frequent prompting to client relationship or
accountability. Requires no supervision when prompted. reflect and adjust based on effectiveness of care.
Demonstrates outcomes. Lacks reflective
awareness of outcomes practice and requires
and client perception, constant supervision.
requiring minimal
guidance.
6. Instituted appropriate The learner proactively identifies actual The learner recognizes The learner responds to The learner fails to
corrective actions to prevent or or potential adverse effects adverse effects and adverse effects but needs recognize or respond
minimize harm arising from and promptly initiates appropriate, initiates timely and frequent appropriately to
adverse effects. evidence-based corrective actions. appropriate corrective prompting or guidance to adverse effects.
Demonstrates excellent clinical measures. Responds choose appropriate actions. Delays or
judgment and ensures client well to clinical cues and May delay interventions or errors in action put
safety. Communicates immediately with follows protocols with overlook contributing client safety at risk.
the team and documents actions minimal supervision. factors. Communication or Needs constant
accurately. No supervision needed. Communication and documentation may be supervision and
documentation are incomplete. correction.
adequate. Poor communication or
lack of documentation.
7. Adhered to ethico-legal The learner consistently upholds ethical The learner adheres to The learner shows basic The learner shows poor
considerations when principles and legal ethico-legal standards in understanding of ethical and understanding or
providing safe, quality, and standards in all aspects of care. most legal responsibilities but disregard for ethico-
professional nursing care. Demonstrates integrity, respect for situations. Demonstrates occasionally legal standards.
patient rights, and accountability. respect, needs reminders or Engages in
Maintains professional boundaries and professionalism, and correction. unprofessional
confidentiality without fail. appropriate use of May unintentionally breach behavior, violates
Serves as a role model in ethical confidentiality and confidentiality, struggle with patient rights or
decision-making. informed consent. informed consent, or confidentiality, or
Seeks demonstrate inconsistent requires
guidance when faced professionalism. constant supervision to
with complex ethical ensure compliance.
issues.
8. Applied ethical reasoning The learner consistently applies ethical The learner applies The learner demonstrates The learner shows little
and the decision-making reasoning frameworks to analyze moral ethical reasoning to most limited application of ethical to no understanding of
process to address dilemmas. situations and uses reasoning ethical reasoning or
situations of ethical distress Demonstrates deep understanding decision-making models and needs frequent structured
and moral dilemma. of ethical principles (e.g., autonomy, effectively with minimal guidance in analyzing moral decision-making. Fails
beneficence, guidance. dilemmas. to
non-maleficence, justice), Identifies key ethical Struggles to identify all recognize moral
evaluates options thoughtfully, and issues, considers stakeholders or implications, dilemmas or respond
chooses actions that uphold patient options, and makes and decisions may lack inappropriately.
dignity and professional appropriate, justifiable consistency or depth. Requires constant
standards. Engages in respectful decisions. supervision and
dialogue and consults appropriate Seeks input when correction.
resources without prompting. needed.

9. Adhered to established The learner consistently demonstrates The learner adheres to The learner shows partial The learner
norms of conduct based on behavior aligned with the Philippine legal and institutional understand nursing laws and demonstrates
the Philippine Nursing Law Nursing Law (RA 9173), Code of Ethics, norms in most situations. institutional policy disregard or lack of
and other legal, regulatory, and institutional policies. Shows a Understands key Adherence is inconsistent; awareness of the
and institutional strong understanding of legal and provisions of the Nursing needs for supervision or
Philippine Nursing
requirements relevant to professional obligations. Maintains Law and institutional correction to ensure with
integrity, accountability, and strict protocols. May need Law or institutional
safe nursing practice. standards. Frequently
compliance with regulatory and occasional reminders,
 institutional standards at all times. but generally, acts in safe nursing practice violates protocols or
Serves as a role model in legal and accordance with regulation behaves
ethical conduct. established standards. unprofessionally.
Requires constant
supervision and
remediation.

10. Protected clients' rights The learner consistently upholds and The learner respects and The learner demonstrates The learner disregards
based on "Patient's Bill of advocates for all aspects of the protects clients’ rights in awareness of patient rights or is unaware of key
Rights and Obligations." Patient’s Bill of Rights (e.g., right to most situations. but may inconsistently apply client rights. Fails to
informed consent, privacy, dignity, Maintains confidentiality, them in practice. Needs maintain confidentiality,
safety, and participation in care obtains consent, and frequent reminders or obtain proper consent,
decisions). Actively educates clients supports client autonomy. correction to maintain or respect client
on their rights and ensures they are Occasionally seeks standards, especially in autonomy. Requires
respected in every interaction. guidance when rights- complex or pressured constant supervision to
Demonstrates strong ethical sensitivity related issues arise. situations. avoid violations.
and professionalism.

11. Implemented The learner demonstrates a thorough The learner appropriately The learner shows partial The learner fails to
strategies/policies related understanding of informed consent applies informed consent understanding of informed follow informed consent
to Informed consent as it across various clinical contexts. strategies in most clinical consent processes. May policies. May skip
Consistently applies policies and situations. Explains omit key information, steps, neglect client
applies in multiple contexts.
educates clients about their rights and procedures clearly, oversimplify explanations, or understanding, or
options. Ensures consent is obtained confirms understanding, struggle with consent in non- improperly document
voluntarily, with full understanding and and respects client routine situations Requires consent. Needs
documentation. Anticipates ethical autonomy. May frequent supervision and constant correction to
concerns and acts proactively to occasionally require reminders. avoid legal and ethical
resolve them. clarification or guidance risks.
in complex cases.
12. Ensured a working The learner consistently demonstrates The learner The learner demonstrates The learner fails to
relationship with the client exceptional communication and communicates effectively basic communication skills build rapport or
and/or support system interpersonal skills that foster trust and and respectfully. Involves but may struggle with active communicate
based on trust, respect, respect. Actively engages the client the client/support system listening, cultural sensitivity, effectively. Shows
and/or support system in shared in decisions and or involving the client fully in limited respect or
and shared decision- decision-making. Uses therapeutic maintains a positive, decisions. Needs frequent empathy, does not
making using appropriate communication, listens empathetically, cooperative relationship. support to maintain involve the client in
communication/interperson and tailors’ interactions to the client’s Occasionally needs therapeutic interactions. decisions, or uses
al techniques/strategies. needs and context. Builds a strong, minor guidance to inappropriate
collaborative nurse-client relationship. enhance communication communication
in challenging situations techniques. Requires
continuous supervision.
13. Documented the client's The learner consistently produces The learner provides The learner documents care The learner fails to
responses /nursing care complete, accurate, timely, and well- generally accurate and inconsistently. Some entries document essential
services rendered and organized documentation. Captures all timely documentation. are vague, incomplete, or care activities or client
relevant client responses, interventions, Most client responses delayed. Needs frequent responses. Entries are
processes/outcomes of the
and outcomes. Uses appropriate and interventions are reminders to follow correct often late, incomplete,
nurse-client working terminology and formats according to recorded appropriately. format, include necessary or inaccurate.
relationship. institutional standards. Demonstrates a Follows documentation details, or record outcomes Demonstrates poor
clear understanding of the importance of protocols with minimal properly. understanding of
documentation in continuity of care and errors or omissions. documentation
legal accountability. Requires little guidance. standards. Requires
constant supervision
and correction.
14. Ensured completeness, The learner consistently ensures that all The learner provides The learner handling of The learner fails to
integrity, safety, accessibility, client records and information is mostly complete and information is inconsistent. ensure the safety or
and security of information. complete, accurate, and up to date. accurate documentation May omit essential details or accuracy of client
Demonstrates excellent understanding and uses secure use inappropriate methods information. May
of data integrity, strictly follows channels to handle client for storing/accessing violate confidentiality,
confidentiality protocols, and uses information. Follows information. Requires mishandle data, or
secure systems to store and access institutional and legal frequent supervision and neglect to document
data. Maintains legal and ethical guidelines, with only correction to maintain important details.
standards at all times. minor lapses. compliance. Poses a risk to client
Understands safety and data
 importance of privacy security; needs
and data protection. constant supervision.

15. Adhered to protocol and The learner consistently upholds strict The learner maintains The learner shows a basic The learner disregards
principles of confidentiality in confidentiality in all situations. Follows confidentiality and understanding of confidentiality
the safekeeping and releasing institutional protocols for safekeeping generally follows policies confidentiality but may principles or
of records and other and release of client records without fail. on handling client require reminders. May misuses/accesses
information. Demonstrates a strong understanding of records. Safely stores inadvertently mishandle client information
legal and ethical responsibilities and releases information information or overlook inappropriately. Lacks
regarding information privacy. with minimal guidance. specific procedures. Needs understanding of
Proactively prevents breaches and Understands relevant frequent supervision to protocols and legal
educates others when needed. laws (e.g., Data Privacy comply with protocols. responsibilities.
Act) and institutional Requires continuous
protocols. supervision to avoid
privacy violations.

Score Range Equivalent % Performance Level

57–60 95–100% Outstanding
53–56 88–94% Very Satisfactory
49–52 82–87% Satisfactory – Above Expectations
45–48 75–81% Satisfactory – Meets Expectations
42–44 70–74% Fair – Minimum Passing
Below 42 Below 70% Unsatisfactory – Requires Remediation

Passing score: 42 out of 60 (70%)

Total Score :_________________ Equivalent Grade: _________________

Student’s feedback (within the context of clinical performance):

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Learner’s Name & Signature : ________________________________ Date: ____________

Clinical Instructor’s Name & Signature: ________________________________ Date: ____________