COLLEGE OF NURSING EVALUATION TOOL

INTRA-OPERATIVE CARE COMPETENCY

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SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-OPERATIVE CARE COMPETENCY In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009 Signature over Printed Name of the Student: ______________________________________

INTRA-OPERATIVE CARE COMPETENCY

DESIRED RATING

1st RLE

2nd RLE

3rd RLE

Average Rating

I. SAFE AND QUALITY NURSING CARE (SQC) 1. Utilizes the nursing process in the care of OR client. 4 a. Obtains comprehensive clients information by checking complete accomplishment of the preoperative checklist/clients chart. b. Identifies priority needs of the client at the Operating 4 Room. c. Provides needed nursing interventions based on identified 4 needs. d. Monitors clients responses to surgery. 2 2. Promotes safety and comfort of patients inside the OR 2 3. Performs the functions of the scrub nurse. 4 a. Performs surgical scrub correctly. b. Wears sterile gowns and gloves aseptically. 2 c. Prepares surgical instruments, sponges, sutures and 2 other supplies in functional arrangement. d. Hands instruments, sponges, sutures and other needed 2 materials according to surgeons preference. e. Performs surgical count accurately. 2 4. Performs the functions of the circulating nurse. 2 a. Anticipates the needs of the surgical team. b. Sets up the OR room needed equipment 2 c. Receives client for surgery/endorses client post2 operatively. d. Assists in skin preparation and draping of client 2 5. Administers medications and other health therapeutics safely. 2 II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE) 1. Organizes work load to facilitate timely patient Care. 4 2. Utilizes adequate and appropriate resources to support the 2 OR team. 3. Ensures functionally of OR resources 2 4. Maintains a safety environment at the OR by observing the 2 principles of asepsis. III. HEALTH EDUCATION (HE) 1. Implements appropriate health education activities to client 2 based on needs assessment. IV. LEGAL RESPONSIBILITIES (LR) 1. Adheres to legal and institutional protocols regarding informed 2 consent V. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. Respects the rights of the OR client 2 2. Accepts responsibility and accountability for own decisions 2 and actions as an OR nurse VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Performs OR functions according to professional standard 4 2. Possesses positive attitude towards learning surgical and OR2 related knowledge and skills.

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VII. QUALITY IMPROVEMENT (QI) 1. Participates in quality improvement activities related to infection control and successful OR operations. 2. Identifies and reports variances in sterility and other OR activities. VIII. RESEARCH (R) 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. Maintain accurate and updated documentation of patient care. X. COMMUNIATION (Comm) 1. Establishes rapport with patients, significant others and members of the health team. 2. Uses appropriate information mechanisms to facilitate communication inside the OR and with other departments in the hospital. XI. COLLOBORATION AND TEAMWORK (CTM) 1. Collaborates plan of care with other members of the health 2 team. TOTAL SCORE

2 2 2

1 2

75

When Graded RLEs were performed (Specify Academic Year and Semester): 1ST Sem_ 2nd Sem. __ Summer____ Signature_____________________ Validity ______________________

First Graded RLE Clinical Instructor

: Academic Year __________________ : Name_________________________ : License Number________________

Second Graded RLE : Academic Year __________________ 1ST Sem_ 2nd Sem. __ Summer____ Clinical Instructor : Name_________________________ Signature_____________________ : License Number________________ Validity ______________________ Third Graded RLE Clinical Instructor : Academic Year __________________ 1ST Sem_ 2nd Sem. __ Summer____ : Name_________________________ Signature_____________________ : License Number________________ Validity ______________________

Verified True and Correct: _____________________________ (Signature over Printed Name) Clinical Coordinator Academic Year Graduated: ___________________ ___________________________ DEAN Signature over Printed Name

License Number_____________ Validity______________________

License Number: _______________ Validity Date ________________

UC-VPAA-CON-FORM-15 JUNE 2012 REV 00

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