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Scrub Performance Evaluation Checklist

This document contains a summary performance evaluation of a student nurse achieving intra-operative care competency at Siena College of Taytay. It evaluates the student across 11 competency areas involving safe nursing care, management of resources, health education, legal responsibility, ethics, professional development, quality improvement, research, records management, communication, and collaboration. The student is rated on a scale of 1 to 4 on multiple criteria within each competency area. The evaluation is signed by both a clinical instructor and the student.

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Ernest Lumba
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829 views2 pages

Scrub Performance Evaluation Checklist

This document contains a summary performance evaluation of a student nurse achieving intra-operative care competency at Siena College of Taytay. It evaluates the student across 11 competency areas involving safe nursing care, management of resources, health education, legal responsibility, ethics, professional development, quality improvement, research, records management, communication, and collaboration. The student is rated on a scale of 1 to 4 on multiple criteria within each competency area. The evaluation is signed by both a clinical instructor and the student.

Uploaded by

Ernest Lumba
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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SIENA COLLEGE OF TAYTAY

College of Nursing
E. Rodriguez Ave. Bgry. San Isidro Taytay, Rizal, Philippines
658-8765/658-8728/660-4762
SUMMARY PERFORMANCE EVALUATION ACHIEVING
INTRA-OPERATIVE CARE COMPETENCY
In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Name of Student: ERNESTMARI ALFRED Z. LUMBA


Legend:
4 Competent (student performs consistently in an effective and efficient manner)
3 Progress acceptable (performance in usually effective and efficient but not always)
2 Needs improvement (progress in performance is too slow to judge satisfactorily; task
performance is not done properly majority of the time)
1 Progress unacceptable (no progress in performance has been demonstrated, and/or
Performance is consistently ineffective and inefficient)

INTRA-OPERATIVE CARE COMPETENCIES Score Remarks


I. SAFE AND QUALITY NURSING CARE (SQC)
1. Utilizes the nursing process in the care of OR client
a. Obtains comprehensive client’s information by checking complete
accomplishment of the preoperative checklist/client’s chart
b. Identifies priority needs of the client at the Operating Room
c. Provides needed nursing interventions based on identified needs
d. Monitors client’s responses to surgery
2. Promotes safety and comfort of patients inside the OR
a. Transports clients safely from the unit to OR
b. Transfers client safely from the stretcher to OR bed, OR bed to stretcher to
RR bed (e.g. use of side rails)
c. Places properly grounding pad under the patient for electro-surgical
equipment
d. Monitors vital signs
e. Provides physical comfort utilizing comfort devices/techniques
f. Provides needed blankets and sheets to prevent hypothermia and provide
privacy
g. Assist in proper and safe positioning of clients in preparation for surgery
h. Observes the principles of strict surgical
i. Aseptic techniques within the work area at all times
j. Observes universal precautions in handling body fluids
3. Performs the functions of the scrub nurse
a. Drapes the operative field correctly
b. Performs surgical scrub correctly
c. Dons surgical gowns and gloves correctly
d. Serves gowns, gloves and drapes aseptically
e. Prepares surgical instruments, sponges, sutures and other supplies in
functional arrangement
f. Hands instruments, sponges, sutures and other needed materials according
to surgeon’s preference
g. Performs surgical count accurately
h. Performs after care of the surgical instruments
4. Administers medications and other health therapeutics safely
5. Executes legal orders of the surgeon/anaesthesiologist accurately and timely
6. Evaluates patient’s response to interventions
7. Monitors patients progress during surgery and immediate post-op phase
II. MANAGEMENT OF RESOURCES AND ENVIRONMENT (MRE)
1. Ensures availability, completeness and functionality of OR equipments
2. Observes protocols in unrestricted, semi – restricted and restricted areas in the OR
3. Performs proper disinfection and sterilization protocols
4. Observes proper handling and up keeping of OR resources
5. Observes OR policies, procedures and protocols on infection control
6. Conducts inventory of OR resources
7. Awareness of the institutional evacuation and location plan both for fire,
earthquake and other major emergencies
III. HEALTH EDUCATION (HE)
1. Implements appropriate health education activities to client based on needs
assessment of the intra-operative client
2. Reinforces pre-operative health teachings to client
IV. LEGAL RESPONSIBILITY (LR)
1. Adheres to legal and institutional protocols regarding informed consent and other
legal documents
V. ETHICO-MORAL RESPONSIBILITY (EMR)
1. Respects the rights of the OR client
2. Accepts responsibility and accountability for own decisions and actions as an OR
nurse
3. Maintains privacy and confidentiality of client’s information
4. Adheres to the Code of Ethics for Nurses
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Performs OR functions according to professional standards
2. Possesses positive attitude towards learning surgical and OR related knowledge and
skills
VII. QUALITY IMPROVEMENT (QI)
1. Reports significant actual or potential observations regarding the surgical client
2. Reports positive or negative variances at the OR
VIII. RESEARCH
1. Disseminates results of OR-related research findings to clinical group and other
members of the OR team as appropriate
IX. RECORDS MANAGEMENT (RM)
1. Maintains legible, accurate and updates documentation of patient care in the
chart/ and OR forms.
2. Submits timely, complete and accurate surgical slips and OR write-ups for cases
handled
X. COMMUNICATION
1. Utilizes therapeutic communication skills with patients, significant others and
members of the health team
2. Establishes professional relationships with members of the surgical/health team
3. Utilizes proper channel of communication
4. Observes complete and accurate endorsement procedures
5. Uses appropriate information mechanisms to facilitate communication inside the
OR and with other departments in the hospital
XI. COLLABORATION AND TEAMWORK (CTM)
1. Collaborates plan of care with other members of the health team

Evaluated by:

____________________________________________ _____________________________ ___


Signature over Printed Name Signature over Printed Name
Clinical Instructor Student

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