Eval Tool - Eljmh

Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

Cabanatuan City
EVALUATIVE TOOL FOR RELATED LEARNING EXPERIENCE
Clinical Area:ELJMH SURGERY WARD
LEVEL III: BSN BLOCK B
Name: Binuya, Geneva Ruz
Year & Block: BSN III B
KNOWLEDGE (40%)
A.Documentation (Reporting
& Recording)10%
B. Problem Solving & Decision
Making, Ward Class, Case
Pres.,NCP 15%
C. Pre-test, Quizzes & PostTest 15%
SKILLS (40%)
A.Execution of Treatment &
Procedure 15%
B.Communication Skills 5%
C. Quality of Nursing Care 5%
D.Health Teaching 5%
E. Utilization and
Implementation of Nursing
Process 10%
ATTITUDE 20%
A.Punctuality/Regular
Attendance 10%
B.Honesty/Courtesy/Grooming
10%
C.Displays right attitude
towards work 5%
Inclusive Dates: July 7

Shift: 11:00 PM to 7:00 AM
2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
35.17
85
86
87
87
86.25
86
87
87
87
86.75
93.3
90
90
90
90.8
34.64
86
86
87
86
87
87
87
86
87
87
87
87
87
87
87
87
86.75
86.75
87
86.5
86
86
86
86
86
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
87.41
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
Clinical Instructors Signature
___________________
Clinical Coordinators Signature
_________________________________
EPPIE DC. BUGARIN, Ph.D.,RN
Dean

Cabanatuan City
Name: Belogot, Annariza
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
34.92
85
86
87
87
86.25
86
87
87
87
86.75
90
88
88
88
89
34.5
86
85
87
86
86
85
87
86
86
86
87
87
87
86
87
87
86.25
85.5
87
86.5
86
86
86
86
86
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
87.02
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Bongcawil, Danielle Mariel Brenn
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
34.37
85
85
85
87
85.5
86
87
87
87
86.5
83.3
85
85
85
85.8
34.56
86
86
87
86
87
86
87
86
87
86
87
87
87
86
87
87
86.5
86
87
86.5
86
86
86
86
86
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
86.53
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Abulan, Chona Mae
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
35.24
86
87
87
87
86.5
86
87
87
87
86.5
93.3
92
90
90
91.32
34.66
87
86
87
86
87
87
87
86
87
87
87
87
87
87
87
87
87
86.5
87
86.5
86
86
86
87
86.25
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
87.5
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Agpalo, Christianne Abigail
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
33.42
85
86
87
86
86
86
86
86
87
86.25
71.6
77
80
85
78.4
34.54
86
86
87
86
86
86
87
86
86
86
87
87
86
86
87
87
86
86
87
86.5
85
85
85
85
85
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
85.56
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Agustin, Leslie
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
34.31
85
86
87
87
86.25
86
87
87
87
86.75
83.33
84
85
85
84.33
34.27
85
85
86
86
85
85
87
86
85
85
87
87
85
85
87
87
85
85
86.25
86.5
85
85
85
86
85.25
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
86.18
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Anastacio, Carmela
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
34.35
85
86
87
87
86.25
86
87
87
87
86.75
85.5
83
85
85
84.62
34.34
86
85
86
86
86
86
86
86
86
86
86
86
86
86
86
86
86
85.75
86
86
85
86
86
85
85.5
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
86.29
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Anday, Roselle
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
34.28
85
86
86
86
85.75
86
87
87
87
86.75
83.5
85
85
85
84.62
34.36
86
85
86
86
86
86
86
86
86
86
86
86
86
86
86
86
86
85.75
86
86
86
86
86
86
86
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
86.24
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Andasan, Rose Ann
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
34
85
86
86
86
85.75
86
87
87
87
86.75
81
82
82
82
82.5
34.6
86
86
87
86
86
86
87
86
86
86
87
87
86
86
87
87
86
86
87
86.5
85
85
85
85
85
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
86.2
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Bonifacio, Jorella
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
33.26
85
85
85
87
85.5
86
86
86
86
86
78
78
78
78
78
33.6
83
84
84
85
83
84
85
83
84
84
85
83
84
84
85
83
84
84
85
84
84
84
84
84
85
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
84.46
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Buenaventura, Kenjie

1ST WEEK
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%
2ND WEEK
3RD WEEK
4TH WEEK
83
83
83
85
85
83
2011
GENERAL
AVERAGE
32.8
83
84
84.5
84
75
76
80
83
78.5
33.94
85
84
84
85
86
85
84
85
85
85
84
85
86
85
84
85
85.5
84.75
84
85
85
85
85
85
85
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
84.34
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Callos, Joyce Argie
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%
ATTITUDE 20%
Attendance 10%
10%
towards work 5%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
34.46
85
86
87
87
86.25
86
87
87
87
86.75
85.5
34.56
86
86
87
86
87
86
87
86
87
86
87
87
87
86
87
87
86.5
86
87
86.5
86
86
86
86
86
17.6
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
86.62
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

Cabanatuan City
Name: Carpio, Wenna
KNOWLEDGE (40%)
& Recording)10%
Pres.,NCP 15%
SKILLS (40%)
Procedure 15%
E. Utilization and
Process 10%

2011
1ST WEEK
2ND WEEK
3RD WEEK
4TH WEEK
GENERAL
AVERAGE
34.04
85
86
87
87
86.25
86
87
87
87
86.75
82.3
34.3
86
85
86
86
86
86
86
86
86
86
86
86
86
86
86
86
86
85.75
86
86
85
85
85
85
85
17.6
ATTITUDE 20%
Attendance 10%
10%
towards work 5%
88
88
88
88
88
88
88
88
88
88
88
88
88
88
88
85.94
Remarks: ___________________________________________________________________________
___________________
Students Signature
________________________
___________________
_________________________________
Dean

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Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

Republic of the Philippines

Inclusive Dates: July 7

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