NURSING HOME VISITATION EVALUATION
Student : __________________________ Date : ________________________
Academic Task :__NURSING VISITATION__
Self [ ] Peer [ ] Teacher [ ]
0 - Not used / Observed 3 - Getting better
1 - Needs Improvement 4 - Good
2 - O.K 5 - Super good
RELATIONSHIP WITH ELDERLY
| 0 | 1 | 2 | 3 | 4 | 5 |
PATIENCE
| 0 | 1 | 2 | 3 | 4 | 5 |
QUESTIONS ASKED
| 0 | 1 | 2 | 3 | 4 | 5 |
CONFIDENCE
| 0 | 1 | 2 | 3 | 4 | 5 |
EFFORT
| 0 | 1 | 2 | 3 | 4 | 5 |
LISTENING SKILLS
| 0 | 1 | 2 | 3 | 4 | 5 |
SENSE OF COMMUNITY RESPONSIBILITY TOWARDS ELDERLY, STUDENTS, NURSING HOME STAFF
| 0 | 1 | 2 | 3 | 4 | 5 |
Positive Comment and a suggestion for growth
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