B.
Sc NURSING IV YEAR
COMMUNITY HEALTH
NURSING
FIELD EXPERIENCE FILE
ROLL NO…………..
SESSION: 2023-24
B.Sc NURSING IV YEAR
COMMUNITY HEALTH
NURSING
FIELD EXPERIENCE FILE
ROLL NUMBER : ………………… GRADE : …………
AREA OF EXPERIENCE : ……………………………………
SIGNATURE SIGNATURE OF H.O.D SIGNATURE OF
CLASS CO-ORDINATOR PRINCIPAL
SIGNATURE OF SIGNATURE OF
INTERNAL EXAMINER EXTERNAL EXAMINER
MODERN MEDICAL INSTITUTE, COLLEGE OF NURSING, RAIPUR
DEPARTMENT OF COMMUNITY HEALTH NURSING
PERFORMANCE EVALUATION PERFORMA
Name of the Student : Course & Year:
Area :
1 2 3 4 5
S.No CRITERIA
P A G V E
I. Knowledge and Understanding about Family:
1. Studied family Health Record and Collect Data
2. Interpret Data Based on Knowledge
II. Home Visit:
3. Preplans are written based on family needs
4. Planning and organization of Home Visit
5. Establish report with the family effectively
III. Health Assessment and Observations:
6. Identification of Problems and Setting of Priorities
7. Plan and Implement Cares based on Needs and Goals
IV. Nursing Activities Carried Out:
8. Application of Scientific Principles
9. Technical Skills During the Procedure
10. Involvement and participation of family members
11. Interpretation, recording, reporting of results
12. Following Standing Orders and Referral Services
V. Health Information and Health Teaching:
13. Use opportunities for Incidental/planned Health teaching
14. Use Appropriate teaching Principles
VI. Post Visit:
15. Report significant information
16. Complete records promptly, precisely and accurately
VII. Evaluation of family health care:
17. Able to evaluate the short term and long term goals
18. Able to revise the family health needs and modify the care
VIII Professional Qualities:
.
19. Professional appearance
20. Interest, Initiative, Responsible, Leadership and attitude
Total Score 100 Score Obtained:
Grading:
80% and above : Excellent
70 – 79% : Very Good
60 – 69% : Good
50 – 59% : Satisfactory
Below 50% : Poor
Remarks and Signature of the Supervisor
MODERN MEDICAL INSTITUTE, COLLEGE OF NURSING, RAIPUR
DEPARTMENT OF COMMUNITY HEALTH NURSING
EVALUATION PERFORMA FOR CASE STUDY
Name of the Student : Course & Year:
Area :
S.N RATING
PARTICULARS SCORE
O 1 2 3 4 5
I ASSESSMENT
1. Assessment of socio economic status
2. Physical assessment
3. Nutritional assessment
4. Coping ability
II Planning
5. Identification of needs/problems
6. Formulating objectives
7. Plan of care
III Implementation
8. Implementation of care
9. Health education
IV. Evaluation
10. Records and reports
Total Marks : 50 Obtained Marks :
Remarks and Signature of the Supervisor
MODERN MEDICAL INSTITUTE, COLLEGE OF NURSING, RAIPUR
DEPARTMENT OF COMMUNITY HEALTH NURSING
EVALUATION PERFORMA FOR CARE PLAN
Name of the Student : Course & Year:
Area :
S.N RATING
PARTICULARS SCORE
O 1 2 3 4 5
I Assessment:
1. Assessment of socio economic status
2. Physical assessment
3. Nutritional assessment
4. Coping ability
II Planning:
5. Identification of needs/problems
6. Formulating objectives
7. Plan of care
III Implementation:
8. Implementation of care
9. Health education
IV. Evaluation:
10. Records and reports
Total Marks : 50 Obtained Marks :
Remarks and Signature of the Supervisor
MODERN MEDICAL INSTITUTE, COLLEGE OF NURSING, RAIPUR
DEPARTMENT OF COMMUNITY HEALTH NURSING
EVALUATION PERFORMA FOR HEALTH EDUCATION
Name of the Student :
Course & Year :
Topic :
Area :
Date :
Name of the Evaluator:
Score
S.No Particulars Grading Obtained By
Student
I Planning:
1. Has she/he submitted plan in time? 1
2. Has she/he shown interest/ initiative? 1
II Subject:
3. Does she/he select a proper topic/subtopic? 1
4. Is the matter relevant to the group? 1
5. Is this knowledge up to date? 1
6. Is this matter reliable? 1
III Presentation:
7. Is the introduction of the topic is interesting 1
8. Is the method of teaching is appropriate? 2
9. Does she/he communicate the idea correctly? 2
10. Is the language used appropriately 2
11. Is her/his speech and manners satisfactory? 2
12. Is she/he effective as a health educator? 2
13. Is the Conclusion of the health talk adequate? 1
IV Participate and Response:
14. Is the response of the participants is positive? 1
15. Does she/he involve participants? 1
16. Does she/he listen and respond appropriately? 1
V Visual Aids:
17. Are they effectively prepared? 2
18. Has she/he Used visual aids correctly? 1
19. Has she/he Used visual aids at the right time? 1
Total
Remarks and Signature of the Supervisor
MODERN MEDICAL INSTITUTE, COLLEGE OF NURSING, RAIPUR
DEPARTMENT OF COMMUNITY HEALTH NURSING
EVALUATION PERFORMA FOR SCHOOL HEALTH TEACHING
Name of the Student :
Course & Year :
Topic :
Area :
Date :
Name of the Evaluator:
Score
S.No Particulars Grading Obtained By
Student
I Planning:
1. Has she/he submitted plan in time? 1
2. Has she/he shown interest/ initiative? 1
II Subject:
3. Does she/he select a proper topic/subtopic? 1
4. Is the matter relevant to the group? 1
5. Is this knowledge up to date? 1
6. Is this matter reliable? 1
III Presentation:
7. Is the introduction of the topic is interesting 1
8. Is the method of teaching is appropriate? 2
9. Does she/he communicate the idea correctly? 2
10. Is the language used appropriately 2
11. Is her/his speech and manners satisfactory? 2
12. Is she/he effective as a health educator? 2
13. Is the Conclusion of the health talk adequate? 1
IV Participate and Response:
14. Is the response of the participants is positive? 1
15. Does she/he involve participants? 1
16. Does she/he listen and respond appropriately? 1
V Visual Aids:
17. Are they effectively prepared? 2
18. Has she/he Used visual aids correctly? 1
19. Has she/he Used visual aids at the right time? 1
Total
Signature of the Supervisor
