Medical Center Manila 7th Main July 19, 2011 STAFF ENDORSEMENT Room No.

.: Patients Initial: Age/Sex Diagnosis: Doctors Order Nurses Note Diet: Physician:

IVF

Medications and Treatment

Laboratory Works And Diagnostic Procedure

Prepared by: __________________________________ __________________________________________________ Student Staff Nurse Medical Center Manila 7 July 19, 2011

Noted by:
th

STUDENT HEAD NURSE Main

NURSING CARE PLAN Room No.: Patients Initial: Age/Sex Diagnosis: Assessment Diagnosis Planning Intervention Rationale Diet: physician:

Evaluation

Prepared by:

Noted by:

_______________ Staff Nurse Medical Center Manila 8th Main July 20, 2011 PERFORMANCE EVALUATION TOOL NAME:
CRITERIA A. 1. 2. 3. 4. 5. 6. 7.

________________ Clinical Instructor

POSITION:
Standard grade Actual grade

8.
9. B. 1. 2. 3. 4. 5. C.

1. 2.
3. 4. 5. 6. D. E.

KNOWLEDGE Assessed health condition accurately. Identifies needs/problems of client before. During, after procedure. Properly intervenes to the identified nursing problems by performance of independent and dependent nursing functions witg minimum supervision. Explain the rationale for each intervention. Evaluates the effectiveness and nursing intervention. Assumes independence and responsibility over signed task. Needs the least supervision when doing assigned task. Documents pertinent observations and cases. Gives appropriate health teachings instruction to clients according to needs. SKILLS Applies the principle of asepsis when preparing materials and equipment. Prepares and set up needed supplies and equipment Uses/operates tool for nursing intervention. Maintain the equipment and supplies used in good woeking condition and in order of care. Reports and record of data are complete and accurate ATTITUDES Established good interpersonal relationship with clients, family, co-workers. Staff, leader and CI. Reports to duty in complete uniform with paraphernalia, properly groomed and on time. Has initiative, responsible and efficient. Shows respect for himself and others. Shows interest and enthusiasm in his work. Submits requirements on time. QUIZZES ATTENDANCE Total

Prepared by: Abellana, Rio Miguel, Caguia Bridgette, Armiza, Carl ________________________ Student Head Nurse V. Mendoza, RN Medical Center Manila 8th Main July 20, 2011 PARAPHERNELIA CHECKLIST STUDENT S NAME BP apparat us Wrist watc h Banda ge scissor Med tray rule r Digital thermpme ter Pen and penci l penlig ht clipboa rd Wet and dry cotto n balls micropo re Nand a Drug handbo ok Tape measu re torniqu et

Noted by: Cherylline

mas k

glove s

Acha, Jan Emman uel Agacid, Cherei Bacerd o, Lea Rose Baytan, Domiqu e Cabab, Joven Cabab, Joven

Prepared by: Abellana, Rio Miguel, Caguia Bridgette, Armiza, Carl ________________________ Student Head Nurse V. Mendoza, RN

Noted by: Cherylline Clinical Instructor

Medical Center Manila 8th Main July 20, 2011 GENERAL APPEARANCE

STUDENTS NAME Uniform Apron Cap Shoes Stockings/socks Nameplate ID Grooming Hair No jewelry Fingernails Perfume Make-up

Acha, Jan Emmanuel

Agacid, Cherei

Bacerdo, Lea Rose

Baytan, Domique

Cabab, Joven

Cabab, Joven

Prepared by: Abellana, Rio Miguel, Caguia Bridgette, Armiza, Carl ________________________ Student Head Nurse V. Mendoza, RN

Noted by: Cherylline Clinical Instructor