OUR LADY OF FATIMA UNIVERSITY

College of Nursing, Cabanatuan Campus

PROGRAM Bachelor of Science in Nursing STUDENT NAME

NCMA-312 RLE YEAR & SECTION
Care of Clients with Problems in INSTRUCTOR
Oxygenation, Fluid and electrolytes,
COURSE
infectious, Inflammatory, and
immunologic Response, and Cellular DATE
Abberations (acute and chronic)

PROCEDURE : SURGICAL SCRUB

EXPECTED OUTCOME : The student should be able to perform surgical scrubbing correctly.
ASSESSMENT TASK : Return Demonstration

Assessment Exceptional Good Average Poor SCORE

Dimension (4) (3) (2) (1)

1. Gathered all Gathered the Gathered Failed to

Gather the the materials materials to the gather the
materials to be to be be used like materials to materials to
used used like gowns, be used like be used.
sterile gloves but brush and
gowns, failed to soap and
sterile prepare forgot to
gloves, brush and prepare sterile
brush, and soap. gowns and
soap. gloves.
2. Inspected Inspected skin Inspected skin Failed to
Inspect skin skin integrity. integrity. integrity. inspect skin
integrity. Remove Removed Removed Failed to integrity
jewelries and nail jewelries jewelries but removed and
polish. and nail forget to jewelries removed
polish. remove nail and nail jewelries
polish. polish. and nail
polish.
3. Complete OR Complete OR Complete Failed to
Wear attire with cap attire with OR attire wear
appropriate and mask. cap but but without complete
attire (complete without cap and OR
OR attire) mask. mask. attire
without
cap
and
mask.
4. Skillfully Skillfully Skillfully Failed to
Opening of observed opened opened open sterile
materials: 4.1.1 principles of sterile gown sterile gown packages
sterile package sterile and create but failed to and
containing the technique in a sterile create a becomes
gown and create opening field but sterile field contaminated
a sterile field materials. open and and open .
4.1.2. sterile drop the and drop
gloves and drop gloves the gloves
the inner outside the outside the
package of the sterile field. sterile field.
gloves on the
sterile field
 5. Able to wet Able to wet Able to wet Failed to wet
At the surgical arms, hands arms and arms but arms, hands
sink; wet arms, and elbows hands but failed to wet and elbows
hands and elbows at the failed to wet hands and at the
surgical sink. elbows at elbows at surgical
the surgical the surgical sink.
sink. sink.
6. Maintained Maintained Maintained Failed to
Hands in upright hands in hands in hands in maintained
position upright upright upright hands in
position. position with position upright
few reminders. with position.
some
reminders.
7. Applied soap Applied soap Applied soap Failed to
Apply soap and and rub and rub and rub hands apply soap
rub hands and hands and hands and and and rub
arms up to 2 arms up to 2 arms up to 2 arms up to 2 hands and
inches above inches above inches above inches above arms up to
elbows elbows with elbows with elbows with 2 inches
no errors. minimal maximal above
errors. errors. elbows
8. Properly Properly rinsed Improperly Failed to
Rinse both hands rinsed both hands but rinsed both rinse both
and arms hands and failed in the hands and hands and
arms. arms. arms. arms

9. Properly got Properly Properly got Failed to get

Get/ask for a the brush, got the the brush but for a brush,
brush. Rinse brush rinse and brush and failed to rinse rinse
and apply soap applied soap rinse but and brush and
with ease. failed to applied applied
applied soap. soap. soap.
10. Skillfully Skillfully Skillfully Failed
Following followed followed followed to follow
hospital hospital hospital hospital hospital
protocol, brush protocols in protocols in protocols in protocols
non dominant brushing the brushing the brushing the .
hand by fingertips, fingertips, fingertips
dominant hand nails, nails and and nails but
starting from the hands and hands but forgot to
fingertips and nails arms. failed to brush hands
and to all areas of brush the and the
the hand and arm arms. arms.

11. Properly Properly rinsed Properly Failed to

Rinse brush rinsed the the brush and rinsed the perform the
thoroughly brush and put put little soap brush and procedure.
and re-apply some soap again. failed to
soap again. put soap
again.
12. Thoroughly Thoroughly Thoroughly Failed to
Brush dominant brushed the brushed the brushed the perform the
hand by dominant hand dominant hand dominant procedure.
non-dominant by by hand by
hand. Follow steps non- non-dominant non-
of no. dominant hand with dominant
11. hand. minimal errors. hand with
maximal
errors.
 13.
Properly Properly rinsed Properly rinsed Failed to
Rinse brush, hands
and arms. Be careful rinsed
not to touch any part
of the sink and
faucet. Repeat steps
11 to 12.
brush, hands brush, hands brush, hands perform the
and arms and and arms and and arms and procedure.
carefully not carefully not carefully not
to touch any to touch any to touch any
part of the part of the part of the
sink sink sink and
and faucet. and faucet but faucet but
Repeat steps failed to repeat failed to
11 step 11. repeat steps
to 12. 11 and 12.
14. Properly Improperly Properly Failed to
Drop the brush into dropped the dropped the dropped the perform the
the sink brush into brush into brush but procedure.
the sink. the sink. outside the
sink.
15. Kept the arms Kept the arms Kept the arms Failed to
Keep arms flexed flexed and flexed but failed slightly flexed perform
and proceed to proceeded to proceed to and almost surgic
the area with to the area the below the al
sterile field with sterile area with waist and asepsi
field. sterile field. proceeds to s.
the area
with sterile
field.

OVERALL SCORE:

Target Raw Score: 45 out of 60. If raw score is less than 45, repeat the return demonstration.

FACULTY SIGNATURE OVER PRINTED NAME