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Pci Eval Tool

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TRINITY UNIVERSITY OF ASIA

ST. LUKE’S COLLEGE OF NURSING

COMPETENCY EVALUATION CHECKLIST


PRACTICING CLINICAL INSTRUCTOR

Name: ______________________________________________ Inclusive Dates: _________________________


Group: ____ Year: _____ Section: ____ Hospital Area: ____________Skill enhancement ____________________

INSTRUCTION: Based on your evaluation, rate the clinical accomplishment of the instructor by writing the scores
that correspond to his/her performance.

Rating Code:
4 – Very Good 3 – Good 2 – Fair 1 – Needs Improvement (NA)

CORE COMPETENCY
SKILLS: 40% 4 3 2 1 NA
Safe and Quality Nursing Care
1. Ensures that new doctor’s orders are noted and carried out accurately.
2. Supervises and monitors performance of students as they perform bedside
nursing procedures.
3. See to it that a student performs bedside nursing activities efficiently,
effectively and on time.
Management of Environment and Resources
4. Ensures cleanliness and adequacy of supplies (CSS, Pharmaceuticals, linens,
etc.) at all times.
Health Education
5. Provides reassuring presence through active listening, therapeutic touch,
and gestures.
Legal Responsibility
6. Checks the completeness of all forms, and accomplishes accurate and
appropriate documentation in all matters concerning patient care.
Ethico-Moral Responsibility
7. Renders nursing care consistent with the client’s bill of rights (i.e.
confidentiality of information, privacy, etc.) Observes confidentiality and
privacy of clients’ records.
Records Management
8. Checks completeness and correctness of records: kardex, diet list and other
hospital forms (Graphic Sheet, Nurse’s Notes, MTR, I & O Sheet, etc.)used in
the care of patients.
9. Maintains an organized system of filing and keeping clients’ records
following the standard chart arrangement.
Communication
10. Transmits and coordinates plan of care to the rest of the healthcare team
through verbal and written endorsements of all patients under their care.
Sub-total grade:

A. KNOWLEDGE: 20% 4 3 2 1 NA
Safe and Quality Nursing Care
1. Identifies health needs of clients and categorizes degree of patient care
required applying the patient care category system.
2. Make rounds to observe effectiveness of care rendered and refers
identified problems to his/her clinical instructor and or the buddy nurse.
3. Knowledgeable of the functionality of equipments used for patient care
(syringe pump, etc.) and help nursing students understand the importance to
patient care.

Management of Environment and Resources


4. Determine tasks and procedures that can be safely assigned to nursing
students in coordination with his/her clinical Instructor.
5. Teaches nursing students to make innovations to whatever resources
available in the care of patient.
Health Education
6. Participates in patient/watcher orientation/education.
7. Gives incidental teachings to student nurses’ developmental activities
(sharing of current/relevant issues and trends) in patient care and
demonstrates corresponding nursing procedures as necessary.
Legal Responsibility
8. Analyzes gathered data to render quality nursing care.
9. Knowledgeable of the indications and adverse reactions of drugs given to
patients to caution student nurses under his/her supervision.
Ethico-Moral Responsibility
10. Respect clients equally regardless of differences in social status, belief,
religion and cultural background.

B. SUPPLEMENTAL LEARNING ACTIVITIES (20%)


1. Examinations (Pre/Post test)
2. Documentation (Program Plans/Drug Studies)
3. Case Analysis
4. Experiential-Reflective Individual/Group Journal
5. Other activities as required (___________).
Sub-total grade:

ATTITUDE: 20% 4 3 2 1 NA
Legal Responsibility
1. Acts in accordance with the established norms of conduct and regulatory
requirements of the college and affiliated institution.
Personal and Professional Growth and Development
2. Projects a positive image of the profession and demonstrates good
manners and right conduct at all times. A role-model to the nursing student’s
under his/her supervision.
3. Responds positively to suggestions/recommendations and constructive
criticisms made by the Clinical Instructor and or buddy nurse.
4. Reports to duty on time in appropriate uniform and with complete
paraphernalia.
Collaboration and Teamwork
5. Establishes rapport and maintains good interpersonal relationship with
clients, colleagues and other members of the health team.
Sub-total grade:

Final Grade:

Remarks:

_______________________________________ ______________________________________
Name/Signature of CI/Date Name/Signature of Student/Date

Interpretation of Rating
4 – Very Good
Demonstrates ingenious use of nursing process and application of scientific principles. Performs tasks safely and with dexterity
in rendering individualized care to clients/patients. Consistently does research and demonstrates the ability to correlate to
clinical practice. Enthusiastic and self-directed in identifying own strength and weaknesses and takes appropriate action.

3 – Good
Consistently well-prepared for each clinical experience. Utilizes the nursing process with supervision and applies scientific
rationale within his/her framework of knowledge. Performs required tasks safely. With guidance, is able to recognize own
strength and weaknesses and takes appropriate action.

2 – Fair
Inconsistently uses the nursing process and applies scientific rationale within his/her framework of knowledge. Inconsistently
performs required tasks safely. Limited insight into own behavior and its complications for professional role. Inadequate
preparation for clinical performance.

1 – Needs Improvement
Does not utilize the nursing process and cannot explain the scientific principle of nursing care and management performed.
Has no sense of direction in rendering care and severely inadequate of clinical skills and theoretical knowledge. Exhibits
negative behavior that is unsuitable to the profession. Has incurred 3 or more absences.

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