FAR EASTERN UNIVERSITY Primary Health Care II Related Learning Experience Student Performance Evaluation Tool 2nd Semester, SY 2007-2008
Name: _____________________________ Grade: ___________
Section: ________ Group: _________ Date: ____________
RLE DAY 2 – Simulated Interview / Bag Technique
Direction: Please rate the student’s degree of performance on each expected behavior using the scale provided below:
2- Expected competency was adequately met
* principles and guidelines were applied/ followed; with minimal improvement needed
* organization of content/ ideas is accurate and clear
1- Expected competency was partially met
*principles and guidelines were followed but some corrections were needed for improvement
* organization of content/ ideas lacks some degree of clarity and accuracy
0- Expected competency was not met
* principles and guidelines were not followed, several corrections were necessary for improvement
*content/ ideas presented are inaccurate and unclear
NA – Not Applicable due to some circumstance(s)
A. Attendance / Attitude (5%)
Behavior
2
1
0
Remarks
1. Reports on time and attends activities punctually
2. Displays proper grooming and wears complete uniform
B. FAMILY ASSESSMENT TOOL (20%)
Behavior
2
1
0
Remarks
1. FHAT is reviewed and revised accordingly to gather complete initial data base of the client family.
2. Questions are adequate to elicit important information – follow up questions are prepared where clarifications may be needed
3. Format is designed to elicit data with accuracy and ease
Total
C. SIMULATED INTERVIEW (CHST & FHAT) (35%)
Behavior
2
1
0
Remarks
1. Explains concisely and correctly the purpose of data gathering
2. Asks appropriate questions in order to elicit accurate data
3. Uses words / language appropriate to the informant’s level of understanding
4. Defines / explains technical terms as needed
5. Maintains appropriate eye contact
6. Utilizes non-verbal communication appropriately
7. Validates informant’s understanding of the question by clarifying and repeating questions as needed
8. Avoids mannerisms/habits which may distract the client’s flow of thought and communication
9. Displays tact and courtesy throughout the conduct of interview
10. Uses appropriate transitional statements to shift from one topic to another
11. Expresses appreciation for the informant’s participation / cooperation
12. Records / documents accurately the data obtained
13. Demonstrates efficient utilization of time throughout the interview
TOTAL
D. BAG TECHNIQUE (35%)
Behavior
2
1
0
Remarks
1. After entering client’s house, take paper lining from top of bag
2. Lay paper on flat surface of table, chest or box, if none, use floor.
3. Place bag on the left side of paper lining with the bag opening facing the working area
4. Open the bag and take out the plastic lining.
5. Lay plastic lining over the paper lining
6. Bring out soap with soap dish and towel
7. Close the bag without locking and perform hand washing
8. After hand washing, put the soap and soap dish on the paper lining (outside the plastic lining) with hand towel on top of the soap dish.
9. Put on the apron observing proper technique.
10. Remove from bag articles needed for care making sure that they are placed within the plastic lining.
11. Place a paper receptacle outside the work area.
12. Close the bag then complete care.
13. Perform after care of articles used. (Articles are usually disinfected using alcohol including the top of the plastic lining)
14. Close and discard the paper receptacle
15. Wash hands.
16. After hand washing, open the bag and return all articles used.
17. Return the soap and soap dish inside the bag last with the hand towel under the soap dish
18. Take off and fold apron using proper technique and return to bag.
19. Fold the plastic lining (clean- side- out) and return to bag.
20. Close and lock the bag.
21. Get the bag, fold the paper lining without touching the contaminated side and discard.
TOTAL
PEER EVALUATION (5%) ----------------------------------------------- _________
TOTAL : _______
*Community assessment tool should be reproduced and ready for use prior to 4th RLE day. Corresponding deductions should be given to the section who fails to accomplish this.
*The Family Health Assessment Tool (FHAT) should also be finalized.
________________________________ _______________________________
Signature of Faculty Over Printed Name Signature of Student
