BATAAN PENINSULA STATE UNIVERSITY

MAIN CAMPUS
College of Nursing and Midwifery www.bpsu.edu.ph
City of Balanga, 2100 Bataan bpsu.cnm.2018@gmail.com

OFFICE OF THE DEAN

VITAL SIGN SHEET

HOSPITAL: _________________________________ WARD: ___________________ SHIFT: 6:00 AM– 2:00 PM
GROUP: ______________ DATE: ___________________

IVF
Bed No. PATIENT’S Name TIME BP PR RR Temp U S REMARKS
Level
7 am
8 am
9 am
10 am
11 am
12 pm
1 pm
2 pm
7 am
8 am
9 am
10 am
11 am
12 pm
1 pm
2 pm
7 am
8 am
9 am
10 am
11 am
12 pm
1 pm
2 pm
7 am
8 am
9 am
10 am
11 am
12 pm
1 pm
2 pm
7 am
8 am
9 am
10 am
11 am
12 pm
1 pm
2 pm
Our Vision Our Mission
A leading university in the Philippines recognized for its proactive To develop competitive graduates and empowered community members
contribution to Sustainable Development through equitable and by providing relevant, innovative and transformative knowledge,
inclusive programs and services by 2030. research, extension and production programs and services through
progressive enhancement of its human resources capabilities and
institutional mechanism.
 BATAAN PENINSULA STATE UNIVERSITY
MAIN CAMPUS
College of Nursing and Midwifery www.bpsu.edu.ph
City of Balanga, 2100 Bataan bpsu.cnm.2018@gmail.com

OFFICE OF THE DEAN

HEAD NURSING EVALUATION BY THE CLINICAL INSTRUCTOR – FORM NO. 4

DATE: ________________________ PERIOD OF TRAINING: _________________________

AREA: ________________________ FINAL GRADE: _________________________
NAME OF HEAD NURSING STUDENT:
__________________________________________________________________________
(PRINT NAME) LAST FIRST MIDDLE

A. INTELLECTUAL ABILITY (30%) __________

 Appropriate presentation/deliberation
of formulated Plans and Program.
 Independent Functions
 Basic Knowledge and Skills
 Bedside/Physical Care
 Support and Comfort
 Gathering Health Information
 Health Teachings
 Dependent / Collaborative Functions
 Student reports to Faculty Member
Under protocols
 Decisions under parameters
Under Physicians Orders
B. APPLICATION OF NURSING CARE PLAN (30%) __________
 Assessment of client’s health care status
 Plan the nursing action based on identified needs and problems
 Implement appropriate Nursing Interventions
 Document and report observation, responses to nursing action
 Evaluate results of Nursing Intervention
C. PERSONAL QUALITIES AND PROFESSIONAL PROFICIENCIES/RELIABILITY (40%) __________
 Interest and willingness to work
 Concern for people
 Compassionate and committed
 Resourceful and creative with balanced emotional condition
 Initiative for self-improvement and service to others
 Perform work through the use of nursing process
 Communicate and relate well to the group and health team
 Total no. of days present ___________
 Total no. of days late ___________
 Total no. od days absent ___________
TOTAL: ___________

REMARKS / CONTINUOUS IMPROVEMENT:

____________________________________________________________________________________________________

_______________________________
Clinical Instructor
Signature over Printed Name

Our Vision Our Mission

A leading university in the Philippines recognized for its proactive
contribution to Sustainable Development through equitable and
inclusive programs and services by 2030.
To develop competitive graduates and empowered community members
by providing relevant, innovative and transformative knowledge,
research, extension and production programs and services through
progressive enhancement of its human resources capabilities and
institutional mechanism.
 BATAAN PENINSULA STATE UNIVERSITY
MAIN CAMPUS
College of Nursing and Midwifery
City of Balanga, 2100 Bataan
OFFICE OF THE DEAN
Our Vision
A leading university in the Philippines recognized for its proactive
contribution to Sustainable Development through equitable and
inclusive programs and services by 2030.
www.bpsu.edu.ph
bpsu.cnm.2018@gmail.com
Our Mission
To develop competitive graduates and empowered community members
by providing relevant, innovative and transformative knowledge,
research, extension and production programs and services through
progressive enhancement of its human resources capabilities and
institutional mechanism.