Ateneo de Zamboanga University

College of Nursing
Summary Performance Evaluation
Achieving Intraoperative Care Competency
In accordance with PRC Board of Nursing Memorandum No !" Series #!!$
%R Scru& Case 'Ma(or)
Name of Student: _______________________________
Legend: (Rating Criteria)
4 Competent (Students performs efciently in an efective and efcient
manner)
3 rogress !ccepta"le (performance is usually efective and efcient "ut not
al#ays)
$ Needs %mprovement (progress in performance is too slo# to &udge
satisfactorily' tas( performance is not
most of t)e time)
* rogress +naccepta"le (no progress in performance )as "een
demonstrated, and or performance is
Consistently inefective and inefcient)
Intra*operative Care Competencies "
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Case
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Remar,s
I Safe and -uality Nursing Care
1. Conducts pre-operative visit of patient for surgery
(preferably the day before/hours before surgery
!. "eceives endorsement of patient for surgery from #ard nurse.
$. %ssesses a client for surgery.
&. Chec's /validates the completeness and accuracy of the pre-
operative chec'list.
(. )bserves universal precautions in handling body fluids.
*. )bserves surgical asepsis in her role as a circulating nurse.
+. ,ransfers patient to/from the stretcher to )" table/bed.
-. %ssists in proper positioning and strapping patient on the )" table.
.. /rotects the client from electrical0 thermal and/chemical in1uries
- /roper placement and monitoring of cautery pad/ground
- %ppropriate blending of temperature of saline for lavage.
- "insing of instruments/tubing soa'ed in chemicals before
serving them to sterile surgical team.
12. /rovides needed blan'ets and sheets to prevent
hypothermia/provide privacy to the patient.
Performs various roles and functions of a scru& nurse
11. /erforms surgical scrub correctly
1!. 3ons go#ns and gloves aseptically
1$. Sets up sterile field0 mayo stand and prep table .
1&. /erforms timely surgical count accurately #ith the circulator.
1(. %ssists surgeons #ith go#ning /gloving.
Intra*operative Care Competencies "
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1*. %ssists surgeons #ith draping and passes off suction/cautery line
1+. Serves correct instruments and other surgical supplies in anticipation
of the needs of the surgeon.
1-. /erforms aftercare of surgical instruments0 needles and blades used.
1.. %pplies sterile dressing
!2. Secures specimen and labels it properly.
Performs appropriate nursing intervention to intra*operative patients
!1. %ssignment: Summari4es important information about anesthesia
drugs and other common )" drugs in &5* inde6 cards (to be brought
every duty day as ready reference
!!. %dministers medications as ordered follo#ing all principles in drug
administration
!$. 76ecutes legal orders of the surgeon/anesthesiologist timely and
accurately
!&. 7valuates outcomes of care and ad1ust nursing interventions as
appropriate
!(. 8onitors patient continuously during surgery and immediate post-
operative phase
!*. /resents a comprehensive case study of an assisted surgical patient.
II Management of Resources and Environment
27.. 7nsures availability0 completeness and functionality0 storage of )"
e9uipment and other resources.
!-. )bserves organi4ation of #or' and proper budgeting of time and
resources.
!.. )bserves )" policies0 procedures and protocol on infection control
and #aste disposal.
$2. /erforms proper disinfection and sterili4ation.
$1. 3isposes ha4ardous and non-ha4ardous #aste properly per agency
policy.
$!. Conducts inventory of )" resources.
III .ealth Education
$$. "einforces pre-operative health teaching to surgical client.
$&. /rovides health education based on identified learning needs of the
intra-operative/post-operative patient and his significant others.
I/ 0egal Responsi&ilities
$(. Chec's and validates the completeness of the informed consent and
other legal forms.
$*. :alidates information documented in the endorsed chart of client for
surgery.
$+. "espects the /atient;s <ill of "ights.
$-. %dheres to the Code of 7thics for Nurses
/I Personal and Professional 1evelopment
$.. %ccepts criticism and recommendation
Intra*operative Care Competencies "
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&2. Courteous and #or's actively #ith the )" staff0 C.=. and other
members of the health team.
&1. /rompt in reporting to ">7 duty.
&!. /rompt in submitting re9uirements.
/II -uality Improvement
&$. =dentifies deviations of practice from the standards of care of patient
in the )".
&&. /articipates in the #ard audit in the )".
/III Research
&(. ?tili4es and shares relevant research findings related to intraoperative
nursing.
I2 Record Management
&*. 8aintains legible0 complete0 accurate and updated documentation of
patient care in the patient;s chart and other )" forms.
&+. Submits timely0 complete and accurate surgical slips/)" #rite-ups for
cases handled
2 Communication
&-. Communicates therapeutically #ith patients and his significant others.
&.. ?tili4es proper channels of communication.
5=. Colla&oration and 3eamwor,
(2. 8aintains a collaborative relationship #ith colleagues and other
members of the health team.
3%3A0 SC%RE 4 #!!
Certi-ed .rue and Correct:
_______________________________________
(Signature over Printed Name)
/R SC+0 C!S1 No2* /R SCR+0 C!S1 No2 $
/R SCR+0 C!S1 No2 3
_____________________ ______________________
______________________
Clinical %nstructor Clinical %nstructor
Clinical %nstructor
PRC i!ense No. ____________ PRC i!ense No. _____________ PRC i!ense
No___________
"a#id unti#$ _____________ "a#id Unti#$ _____________ "a#id Unti#$
___________
Noted 0y: ________________________
0S Nursing Level Coordinator
PRC i!ense No. _______________
"a#id Unti#$ ________________