Ateneo de Zamboanga University College of Nursing Summary Performance Evaluation Achieving Intraoperative Care Competency In accordance with PRC

Board of Nursing Memorandum No. 01 Series 2009 OR Circulating Case (Major) Name of Student: Arnad, Ed Robert D.C.
Legend: (Rating Criteria) 4 Competent (Students performs efficiently in an effective and efficient manner) 3 Progress Acceptable (performance is usually effective and efficient but not always) 2 Needs Improvement (progress in performance is too slow to judge satisfactorily; task performance is not most of the time) 1 Progress Unacceptable (no progress in performance has been demonstrated, and or performance is Consistently ineffective and inefficient) 2nd Cas e 3rd Cas e

Intra-operative Care Competencies I. Safe and Quality Nursing Care 1. Conducts pre-operative visit of patient for surgery (preferably the day before/hours before surgery) 2. Receives endorsement of patient for surgery from ward nurse. 3. Assesses a client for surgery. 4. Checks /validates the completeness and accuracy of the pre-operative checklist. 5. Observes universal precautions in handling body fluids. 6. Observes surgical asepsis in her role as a circulating nurse. 7. Transfers patient to/from the stretcher to OR table/bed. 8. Assists in proper positioning and strapping patient on the OR table. 9. Protects the client from electrical, thermal and/chemical injuries - Proper placement and monitoring of cautery pad/ground - Appropriate blending of temperature of saline for lavage. - Rinsing of instruments/tubing soaked in chemicals before serving them to sterile surgical team. 10. Provides needed blankets and sheets to prevent hypothermia/provide privacy to the patient. Performs various roles and functions of a circulating nurse 11. Prepares all the needed equipment and supplies for surgery. 12. Assists the anesthesiologist during the induction of anesthesia.

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13. Performs surgical skin prep to the patient. 14. Checks with the scrub nurse the completeness of sponges, instruments and needles used. 15. Anticipates the needs of the sterile surgical team. 1st Case 2nd Cas e 3rd Cas e Remark s

Intra-operative Care Competencies

16. Ensures the intactness and functionality of all contraptions (eg. IVF, BT, IFC, NGT) 17. Continuously monitors aseptic technique and patients needs. 18. Receives specimen and labels it correctly. 19. Prepares patient for transfer to PACU. 20. Helps in the aftercare of all equipment and the OR as a whole. Performs appropriate nursing intervention to intraoperative patients 21. Assignment: Summarizes important information about anesthesia drugs and other common OR drugs in 4X6 index cards (to be brought every duty day as ready reference) 22. Administers medications as ordered following all principles in drug administration 23. Executes legal orders of the surgeon/anesthesiologist timely and accurately 24. Evaluates outcomes of care and adjust nursing interventions as appropriate 25. Monitors patient continuously during surgery and immediate post-operative phase 26. Presents a comprehensive case study of an assisted surgical patient. II. Management of Resources and Environment 27. . Ensures availability, completeness and functionality, storage of OR equipment and other resources. 28. Observes organization of work and proper budgeting of time and resources. 29. Observes OR policies, procedures and protocol on infection control and waste disposal. 30. Performs proper disinfection and sterilization. 31. Disposes hazardous and non-hazardous waste properly per agency policy. 32. Conducts inventory of OR resources. III. Health Education 33. Reinforces pre-operative health teaching to surgical client. 34. Provides health education based on identified learning needs of the intra-operative/post-operative patient and his significant others. IV. Legal Responsibilities 35. Checks and validates the completeness of the informed consent and other legal forms.

36. Validates information documented in the endorsed chart of client for surgery. 37. Respects the Patients Bill of Rights. 38. Adheres to the Code of Ethics for Nurses VI. Personal and Professional Development 39. Accepts criticism and recommendation 1st Cas e 2nd Cas e 3rd Cas e Remar ks

Intra-operative Care Competencies

40. Courteous and works actively with the OR staff, C.I. and other members of the health team. 41. Prompt in reporting to RLE duty. 42. Prompt in submitting requirements. VII. Quality Improvement 43. Identifies deviations of practice from the standards of care of patient in the OR. 44. Participates in the ward audit in the OR. VIII. Research 45. Utilizes and shares relevant research findings related to intraoperative nursing. IX. Record Management 46. Maintains legible, complete, accurate and updated documentation of patient care in the patients chart and other OR forms. 47. Submits timely, complete and accurate surgical slips/OR write-ups for cases handled X. Communication 48. Communicates therapeutically with patients and his significant others. 49. Utilizes proper channels of communication. XI. Collaboration and Teamwork 50. Maintains a collaborative relationship with colleagues and other members of the health team. TOTAL SCORE : 200

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_______________________________________ (Signature over Printed Name) OR CIRCULATING CASE No.1OR CIRCULATING CASE No. 2 OR CIRCULATING CASE No. 3 ___________________________ Clinical Instructor PRC License No. ___________ ___________________________ Clinical Instructor PRC License No. ___________ ___________________________ Clinical Instructor PRC License No. ___________

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Noted By: Ms. Ma. Lourdes C. Follero RN, MN BSNursing Level Coordinator License No. _______________ Valid Until: _______________