FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
Primary Health Care II Related Learning Experience
Student Performance Evaluation Tool
2nd Semester, SY 2007-2008
Name: ____________________________ Grade: ____________
Section: _______ Group: ________ Date: _____________
RLE DAY 4 – COMMUNITY SURVEY PREPARATION / ASSESSMENT OF CLIENT FAMILY
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 prescribed uniform
b. Preparation for Actual Survey (30%)
Behavior
2
1
0
Remarks
1. Responsibly delineates the process of actual data gathering (group leaders / over-all leaders)
2. Actively participates in the planning of data gathering activities (student)
3. Contributes significantly in planning with own group necessary preparation for the upcoming data gathering activities.
4. Willingly accepts the assigned responsibilities in the implementation of the community health survey (student)
5. Performs willingly and adequately his/her assigned task(s) (student)
6. Closely coordinates with the community officials and key persons the plan for data gathering activities. (class)
6. Exhibits resourcefulness and creativity in preparing the spot map (specific student/s)
7. Promptly submits the improved draft of the community spot map (assigned students)
TOTAL
C. Assessment of Client Family (55%)
BEHAVIOR
2
1
0
Remarks
1. Re-establishes rapport with foster family prior to assessment.
2. Explains tactfully and confidently purpose of assessment.
3. Conducts gross physical assessment properly / Obtains vital signs of family members accurately.
2. Interviews efficiently appropriate member(s) of the foster family.
3. Utilizes follow up questions when necessary for clarification.
4. Utilizes appropriate eye-contact and displays sensitivity to non-verbal cues exhibited by informant.
5. Adapts use of terms and language to client’s level of understanding.
6. Demonstrates effective time management in completion of tasks.
8. Submits comprehensive / accurate data reflective of interview and observations.
7. Submits draft of foster family’s initial database on time.
9. Sets contract with foster family regarding subsequent activity.
Total
*Items marked as N.A. should not be included in the computation of the Perfect Score
PEER EVALUATION (5%) ------------------------------------------------------------ ___________
REFLECTION PAPER (5%) ---------------------------------------------------------- ____________
________________________________ _______________________________
Signature of Faculty Over Printed Name Signature of Student
