FM-LPU-NRSG-06a/06
College of Nursing
Telephone No. (043) 723-0706 loc. 109 / 110
PERFORMANCE EVALUATION CHECKLIST
Nursing Care Management 116
EMERGENCY ROOM
Name of Student: _____________________________________________________________________________
Year / Clinical Group: _______________________ School Year: ______________________________
Semester / Term: __________ First Semester: __________ Second Semester: __________ Summer: __________
Inclusive Dates of Clinical Rotation: _______________________________________________________________
Legend:
2 Progress Acceptable (Performance is usually effective and efficient )
1 Needs Improvement (Progress in performance is too slow to judge satisfactorily; task performance
is not done properly for majority of the time)
KEY AREAS OF RESPONSIBILITY Pass Repeat REMARKS
I. SAFE AND QUALITY NURSING CARE (SO a)
1. Promote safely and comfort of patients inside the ER
1.1 Receive client for emergency treatment and transport safely to the area of admission with
proper identification.
1.2 Secure inform consent for admission and for minor operation.
1.3 Check and prepare medication.
1.4 Assist in proper positioning of client during emergency care.
2. Perform the functions of the emergency nurse.
2.1 Obtain client health history including personal, social and history of present illness
2.2 Conduct comprehensive health assessment
2.3 Gather other data related to the health condition (laboratory and diagnostic)
2.4 Identify the client priority needs (Nursing Diagnosis)
2.5 Develop comprehensive client care plan maximizing opportunities for prevention of
problems and/or enhancing wellness response.
2.6 Explain interventions to client and family before carrying out to achieve identified
outcomes.
2.7 Implement nursing interventions
2.7.1 Assist in different medical procedures (suctioning, inhalation, oxygenation,
positioning and others)
2.7.2 Administer medication and other health therapeutics safely
2.7.3 Perform wound care
2.7.4 Transfer client from ER to the ward and other special areas
2.7.5 Endorsement of client
3. Evaluate patient’s response to interventions.
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (SO a)
1. Ensure availability, completeness, proper handling and functionality of ER equipment
2. Adhere to ER policies, procedure, protocols in prevention and control of infection.
III. HEALTH EDUCATION (SO a)
1. Obtain relevant information to identify learning needs of emergency client and significant
others
2. Conduct appropriate health teaching based on needs assessment
3. Evaluate client and family response to health education and respond to questions.
IV. LEGAL RESPONSIBILITY (SO d)
1. Demonstrate sense of responsibility in performing instrument, sponge, and needle count
2. Ensure safety of client in the emergency room.
3. Render nursing intervention consistent with the client’s bill of rights.
V. ETHICO-MORAL RESPONSIBILITY (SO d)
1. Respect the religious, cultural and ethnic practices of the client and his/her family.
2. Ensure privacy of client
3. Ensure confidentiality client’s records
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (SO e)
1. Project the professional image of a nurse.
2. Accept criticisms and recommendations
3. Demonstrates situational flexibility and adaptability.
4. Demonstrate punctuality in reporting to duty
VII. QUALITY IMPROVEMENT (SO d)
1. Identify deviation of practice from the standards.
2. Report significant changes in the client’s condition/environment to improve stay in the hospital
VIII. RESEARCH (SO i and j)
1. Submit case analysis written output
2. Present case during bedside discussion
3. Present individual drug study before drug administration
FM-LPU-NRSG-06a/06
College of Nursing
Telephone No. (043) 723-0706 loc. 109 / 110
KEY AREAS OF RESPONSIBILITY Pass Repeat REMARKS
IX. RECORDS MANAGEMENT (SO b)
1. Accomplish accurate documentation in all matters concerning client care in accordance to the
standards of nursing practice.
2. Maintain an organized system of filing and record keeping.
3. Complete client’s clinical portfolio.
4. Complete synthesis journal (diary).
X. COMMUNICATION (SO k)
1. Utilize therapeutic communication with the client and significant others.
2. Inform client of relevant information about the present condition,
3. Listen attentively to queries and requests of client and family members.
4. Establish trust and confidence.
XI. COLLABORATION AND TEAM WORK (SO c)
1. Maintain good interpersonal relationship with clients, colleagues and other members of the
health team.
2. Refer clients to appropriate allied team partners
3. Participate and contribute in group activities
ASSESSMENT EXAM
4 – Passed, 1 – Failed
Total Score:
Over-all Performance Rating ____________________
Remarks
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Evaluatee: Evaluator:
_________________________________ ________________________________________
Signature of Student Over Printed Name Signature of Clinical Instructor Over Printed Name
Date Date
__________________________ __________________________
