Clinical Practicum Evaluation Report

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  • Objectives
Clinical Practicum Evaluation Reporttest logo 3

Student Name: Student No.

Programme: Bachelor of Health Science (Hons): Applied Gerontology

Hospital/ Institute: Ward/ Specialty:


Types of assessment: Formative (F) Date: Summative (S) Date:


Standard Procedure

Quality of Performance



  • Safe

  • Accurate

  • Effect - each time

  • Affect - each time

Without supportive cues


  • Safe

  • Accurate

  • Effect - each time

  • Affect - each time

Occasional supportive cues


  • Safe

  • Accurate

  • Effect - most of the time

  • Affect - most of the time

Frequent verbal and occasional physical directive cues in addition to supportive ones


  • Safe but not alone; Performs at risk

  • Accurate – not always

  • Effect – occasionally

  • Affect - occasionally

  • Unskillful and inefficient

  • Considerable expenditure of excessive energy

  • With prolonged time period

Continuous verbal and frequent physical cues



Unable to demonstrate behaviour

  • Unable to demonstrate procedure/ behaviour

  • Lacks confidence, coordination, and efficiency

Continuous verbal and physical cues


Not applicable / Not Observed

Bondy, K.N. (1983). Criterion-Referenced Definitions for Rating Scales in Clinical Evaluation. Journal of Nursing Education, 22 (9), 376-381.

Krichbaum, K., Rowan, M., Duckett, L., Ryden, M.B. & Savik, K. (1994). The clinical evaluation tool: a measure of the quality of clinical performance of baccalaureate nursing students. Journal of Nursing Education, 33 (9), 395-404.

Lofmark, A. & Thorell-Ekstrand, I. (2004).  An assessment form for clinical nursing education: a Delphi study.  Journal of Advanced Nursing, 48(3): 291-298.

 Watson, R., Stimpson, A., Topping, A. & Porock, D. (2002).  Clinical competence assessment in nursing: a systematic review of the literature.  Journal of Advanced Nursing, 39(5): 421-431.

Woolley, G. R., Bryan, M. S. & Davis, J. W. (1998). A Comprehensive approach to clinical evaluation. Journal of Nursing Education, 37 (8), 361-366.

Note: Students must score 3 or above for all objectives in order to obtain a satisfactory grade.








1.1 Collects data for assessment from a variety of sources.

1.2 Identifies presence of health and/or social risk factors.

1.3 Identifies potential problems by differentiating normal and abnormal behaviour of elderly and their families.

1.4 Interprets data based on acquired knowledge.

1.5 Identifies health and/or social problems.

1.6 Establishes priorities of care.



2.1 Develops goals with specific time frame based on the needs of elderly.

2.2 Identifies interventions and services appropriate to the elderly problems.

2.3 Incorporates elderly and family strengths and weakness in planning.

2.4 Identifies learning needs of elderly.



3.1 Uses communication techniques appropriate to elderly situation.

3.2 Provides safe and competent care.

3.3. Responds appropriately and detects verbal and non-verbal cues of elderly and their family.

3.4 Respects the rights and dignity of elderly and their significant others.

3.5 Provides health teaching based on identified learning needs.

3.6 Makes referrals for elderly based on their needs.



4.1 Utilizes the problem-oriented method for recording relevant data.

4.2 Evaluates outcomes of care.

4.3 Develops alternative interventions.


Professional Behaviours

5.1 Recognizes own strengths and limitations.

5.2 Demonstrates ability to reflect own competency, feeling and understanding of work situations through keeping of learning diary or journal.

5.3 Seeks guidance as appropriate.

5.4 Demonstrates ability to criticize own performance for continuing development.

5.5 Communicates with other care team members on overall plan for elderly.

5.6 Participates in group conference and shares pertinent learning experience.

5.7 Reports on time.

F = Formative Assessment

S = Summative Assessment
Narrative Comments

(Summative evaluation)



Overall Performance: Satisfactory / Unsatisfactory
Student Signature Date
Supervisor Signature _______________________ Date


Updated on 25 April 2014

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