1.
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SCHOOL OF NURSING AND MIDWIFERY
DEPARTMENT OF GENERAL NURSING
CLINICAL PRACTICE EVALUATION TOOL
NAME OF STUDENT: …………………………………......................................................Registration Number :………………
YEAR / LEVEL : ……………………………………………………………………………………….. ………………………………
CENTER OF EXAMINATION: ……………………………………………………………………………………………………….
WARD / SERVICE : ……………………………………………………………………………………………………………………..
DATE: ………………………………………………………………………………………… TIME:…………………………………
NO MAXIMUM MARKS
RECEIVED
RESULT EVALUATORS COMMENTS
AND OBSERVATIONS
1 Training book completed 1mark
2 Professional appearance and personal cleanliness
1. Present in appropriate clean,
2. fitting full uniform (Head and hair tied and covered with
a cap)
3. Present with short nails and clean
4. Watch and jewels removed
5. Closed- toe footwear
6. Has identification card
2.5marks
0.5
0.5
0.5
0.5
0.5
College of Medicine and Health Sciences

2.
3 Introduction
1. Student is introduced to examiner
2. Student is introduced to staff and asking permission to
see his/her own client
3. Hand washing
4. Identify client correctly
5. Introduced to client
6. Explain the client and care taker the reason
7. Asking consent form
3.5 marks
0.5
0.5
0.5
0.5
0.5
0.5
0.5
4 Material preparation for assessment
1. Hand washing
2. Proper material preparation (clean and disinfect the
plate or the trolley)
3. Checking of material working and appropriate
repositioning of materials
4. Good manipulation of materials
5. Respect the asepsis during preparation
6. Stress management during material preparation
7. Time management during material preparation
/ 5marks
0.5
1
0.5
1
1
0.5
0.5
5 Assessment
1. Hand washing / Hand rubbing
2. Environment and observation skills
3. Privacy and intimacy of patient
4. Use of materials correctly and appropriately
5. Use of correct questions and obtain correctly
information from the client
6. Use of appropriate and correctly the approach of
physical examination (inspection, palpation, percussion
and auscultation)
7. Asepsis during assessment
8. Time management in assessment
9. Reposition of client comfortably
10. Collaborate well with client *
/ 20 marks
1
1
1
3
3
5
2
1
1
1

3.
11. Material discarding 1
6 Client presentation to the examiner(s)
1. Present completely the client identification all component of
history taking are mentioned
2. The parts of care plan are presented
3. Content is critical, meaningful coherent to client needs
4. Make appropriate and prioritized nursing diagnosis
5. Sets SMART goals /expected outcomes
6. Select appropriates interventions
7. Set appropriates priorities during clinical interventions
8.The interventions are rationalized
/ 10 marks
1
1
2
2
1
1
1
1
7 Skills performance
Preparation of care:
1. Inform and explain the procedure to the client /family and
obtain consent
2. Wash hand / hand rubbing by respecting the steps of
technique
3. Prepare materials correctly *
4. Respect of asepsis during preparation*
5. Proper manipulation of material
Carry out nursing care procedures
6. Positioning of client correctly
7. Good position of materials
8. Maintain client privacy
9. Hand rubbing
10. Demonstrate competency by respecting steps and
appropriate acquisition of each steps*
11. Respect principles of asepsis during performing*
12. Manage time effectively
13. Efficient use available materials
14. Maintain a collaboration with client and /or relative
15. Provide appropriate health education to client
/ 40 marks
1
1
4
3
1
1
1
1
1
5
5
1
1
1
3

4.
Completion of procedures:
16. Thanking the client
17. Repositioning of client and his or her belongs
18. Discard and arrange materials appropriately
19. Hand washing
20. Documents assessment done
21. Document procedure done
22. Document and report relevant observations made during
procedures
23. Document of outcomes of interventions
24. Provide oral report to nurses
1
1
1
1
1
1
2
1
1
8 Professional behavior and attitudes
1.Communicate with the team staff, client/family*
2. Use of appropriate language
3. Advocate for client
4. Show critical thinking and observation skill
5. No unnecessary movement done
6. Acceptance of feedback accurately
7. Honest
8. Respect/ Modesty
/ 5marks
1
0.5
0.5
1
0.5
0.5
0.5
0.5
9 Theory
1. Answer all questions concerned to client condition
2. Able to explain the benefit and risk related to procedure
performed
3. Describes therapeutic interventions for patient, and their
appropriateness based on patient situation (includes
medications, procedures, labs, etc.)
/ 10 marks
4
2
4
10 Self evaluation
1. Identify her/his own strengh,weakness ( Recognize well
her/his own mistakes and where needed crucial improvement )
2. Recognize the gaps and able to honestly in scoring he/her self
/ 3marks
1.5
1.5

5.
TOTAL MARKS :………../100MARKS
General Comments:
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Areas for Improvement:
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Names, signature of student and date:………………………………………………………………………………………………
Names, signature of first examiner and date :………………………………………………………………………………………
Names, signature of second examiner and date:……………………………………………………………………………………
Date:……………………………………………………………………………………………………………………………………….