Cebu Normal University

College of Nursing Osmea Boulevard Cebu City 6000 254 4837 / cnucollegeofnursing@live.com.ph SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRAOPERATIVE CARE COMPETENCY In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009-08-08 Signature over Printed Name of Student: __________________________________________________
SUMMARY OF MAJOR CASE Desire 1st 2nd 3rd 4th 5th Intraoperative Care Competencies d RLE RLE RLE RLE RLE Rating I. SAFE AND QUALITY NURSING CARE (SQC) 1. Utilizes the nursing process in the care of OR clients. a. Obtains comprehensive client information by checking complete 4 accomplishment of the preoperative checklist/clients chart. b. Identifies priority needs of the client 4 at the operating room. c. Provides needed nursing interventions based on identified 4 needs. d. Monitor clients response to 2 surgery. 2. Monitors safety and comfort of 2 patients inside the OR. 3. Performs the function of the scrub nurse. a. Performs surgical scrub correctly. 4 b. Wears sterile gown and gloves 2 aseptically. c. Prepares surgical instrument, sponges, sutures and other supplies 2 in functional arrangement. d. Hands instruments, sponges, sutures and other needed materials 2 according to surgeons preference. e. Performs surgical count accurately. 2 4. Performs the functions of the circulating nurse. a. Anticipates the need of the surgical 2 team. b. Sets up the OR and needed 2 equipment. c. Receives client for surgery/endorses 2 client post-operatively. d. Assists in skin preparation and 2 draping of the client. 5. Administers medications and other 2 health therapeutics safely. II. MANAGEMENT OF RESOURCES AND ENVIRONMENT (MRE) Avera ge Rating

1. Organizes workload to organize 4 timely patient care. 2. Utilizes adequate and appropriate 2 resources to support the OR team. 3. Ensures functionality of OR 2 resources. 4. Maintains a safe environment at the OR by observing the principles of 2 asepsis. III. HEALTH EDUCATION (HE) 1. Implements appropriate health education activities to clients based 2 on needs assessment. IV. LEGAL RESPONSIBILITIES (LR) 1. Adheres to institutional and legal 2 protocols regarding informed consent. V. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. Respects the rights of the OR client. 2 2. Accepts responsibility and accountability for own decisions and 2 actions as an OR nurse. VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Performs OR functions according to 4 professional standards. 2. Possesses positive attitude towards learning surgical and OR related 2 knowledge and skills. VII. QUALITY IMPROVEMENT (QI) 1. Participates in quality improvement activities related to infection control 2 and successful OR operations. 2. Identifies and reports variances in 2 sterility and other OR activities. VIII. RESEARCH (R) 1. Disseminates results of OR related research findings to clinical group and 2 other members of the OR team as appropriate. IX. RECORD MANAGEMENT (RM) 1. Maintains accurate and updated 2 documentation of patient care. X. COMMUNICATION (COMM) 1. Establishes rapport with patients, significant others and members of the 1 health team. 2. Uses appropriate information mechanisms to facilitate 2 communication inside the OR and with other departments in the hospital. XI. COLLABORATION AND TEAMWORK 1. Collaborates plan of care with other 2 members of the health team. TOTAL SCORE: 75

When graded RLEs were performed (Specify Academic Year and Semester)

First Graded RLE: _______

Academic Year___________________ 1st Sem____ 2nd Sem ______ Summer

Clinical Instructor: Name:__________________________________ Signature: _____________________ License Number__________________________ Validity: _______________________

Second Graded RLE: Summer _______

Academic Year___________________ 1st Sem____ 2nd Sem ______

Clinical Instructor: Name:__________________________________ Signature: _____________________ License Number__________________________ Validity: _______________________

Third Graded RLE: Academic Year___________________ 1st Sem____ 2nd Sem ______ Summer _______ Clinical Instructor: Name:__________________________________ Signature: _____________________ License Number__________________________ Validity: _______________________

Fourth Graded RLE:Academic Year___________________ 1st Sem____ 2nd Sem ______ Summer _______ Clinical Instructor: Name:__________________________________ Signature: _____________________ License Number__________________________ Validity: _______________________

Fifth Graded RLE: _______

Academic Year___________________ 1st Sem____ 2nd Sem ______ Summer

Clinical Instructor: Name:__________________________________ Signature: _____________________ License Number__________________________ Validity: _______________________

Academic Year Graduated: ________________________

_______________________________________ DEAN

License Number_____________________ Validity Date________________________