BLANCIA COLLEGE FOUNDATION, INCORPORATED

College of Nursing

SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-OPERATIVE COMPETENCY

In Accordance with PRC Board of Nursing Memorandum No. 01 Series of 2009

Name of Student:___________________________________

Year Level:_____________

DESIRED 1st 2nd 3rd FINAL

INTRAOPERATIVE COMPETENCIES (CIRCULATING NURSE)
RATING RATING
I. SAFE AND QUALITY NURSING CARE (SQC)
A. UTILIZES THE NURSING PROCESS IN THE CARE OF O.R. CLIENT
1. Obtains comprehensive client’s information by checking complete
4
accomplishment of the preoperative checklist/clients chart.
2. Makes sure theater is clean. 2
3. Provides clean kick bucket and pail. 2
4. Identifies priority needs of the client upon admission to the Operating
4
Room
5. Provides needed nursing intervention based on identified needs.
a. Patient transfer to stretcher. 1
b. Patient transfer to O.R. table. 1
c. Allay patient’s anxiety and questions. 1
d. Patient’s comfort (serving of bedpan, etc.) 1
B. FUNCTIONS AS CIRCULATING NURSE
1. DURING THE INDUCTION OF ANESTHESIA
a. Turn on O.R. light. 1
b. Assists in positioning the patient. 2
2. AFTER THE PATIENT IS ANESTHESIZED
a. Assists in repositioning of the patient per anesthesiologist order. 2
b. Attaches anesthesia screen and places the patient’s arms on the
2
arm boards.
c. Applies restraints on the patient. 2
d. Exposes the area for skin preparation. 2
e. Observes skin preparation. 2
3. DURING OPERATION
a. Remains in the theater throughout the procedure. 2
b. Focuses the O.R. light as needed. 2
c. Connects equipment/machines (cautery machine, suction
2
machine).
d. Positions kick buckets on the operating side. 1
e. Replenishes and records sponge/sutures. 5
f. Ensures the theater door remains close and patient’s dignity is
5
upheld.
g. Maintains a safe environment at the O.R. by observing the
5
principles of asepsis and sterility.
h. Monitors client’s responses to surgery. 4
i. Initiates and assists with final sponge and instruments count. 2
4. AFTER OPERATION
a. Helps remove and dispose drapes. 1
b. Assists the scrub nurse, with after care of the instruments and
2
equipment.
c. Ensures that the theater is ready for the next case. 3
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND
EQUIPMENT (MRE)
a. Organizes work load to facilitate timely patient care. 4
b. Utilizes adequate and appropriate resources to support the O.R.
2
team.
c. Ensures functionality of O.R. resources. 2
III. HEALTH EDUCATION (HE)
a. Implements appropriate education activities to client based on 2
 needs assessment.
IV. LEGAL RESPONSIBILITIES (LR)
a. Adheres to legal and institutional protocols regarding informed
2
consent.
V. ETHICO-MORAL RESPONSOBILITIES (EMR)
a. Respects the right of the O.R. patient. 2
b. Accepts responsibility and accountability for own decisions and
2
actions as an O.R. nurse.
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
a. Performs O.R. functions according to professional standards. 4
b. Possesses positive attitude towards learning surgical and O.R.
2
activities.
VII. QUALITY IMPROVEMENT (QI)
a. Participates in quality improvement activities related to infection
2
control and successful O.R. operations.
b. Identifies and reports variances in sterility and other O.R. activities. 2
VIII. RESEARCH (R)
a. Disseminates results in O.R. related research findings to clinical
2
group and other members of the O.R. team as appropriate.
b. Utilize findings of research studies in immediate care of the post-
2
operative care.
IX. RECORD MANAGEMENT (RM)
a. Maintain accurate and updated documentation of the patient care. 2
X. COMMUNICATION (COMM)
a. Establishes rapport with patients, significant others and members
1
of the health team.
b. Uses appropriate information mechanics to facilitate
communication inside the O.R. and with other departments in the 2
hospital.
XI. COLLABORATION AND TEAMWORK (CT)
a. Collaborates plan of care with the other members of the health
2
team.
TOTAL 100

Evaluated by: ________________________________

Clinical Instructor