JOSE RIZAL UNIVERSITY

College of Nursing and Health Sciences

Performance Checklist
Care and dressing of Wounds

Name of Student: ___________________________ Date: ___________

Year/Section/Group No.: ________________ Grade: __________

Rate the student’s performance by checking the appropriate box using the following criteria:

5- Excellent (Carries out procedure efficiently and systematically)

4- Very Satisfactory (Carries out procedure efficiently or systematically, requires minimal guidance and supervision)

3- Satisfactory (Carries out procedure efficiently or systematically, requires moderate guidance and supervision)

2- Fair (Carries out procedure with close guidance and supervision)

1- Poor (Unable to perform the procedure)

5 4 3 2 1
A. KNOWLEDGE – 30%
1. States objectives of this activity.
2. Uses appropriate terms.
3. States steps of the procedure in correct order.
4. Explains the rationale of every step.
B. SKILLS – 60%
5. Assemble all equipments and bring to bedside.
6. Explain the procedure to the client.
7. Do the medical hand washing.
8. Position the client according to site of the wound.
9. Expose the wound and drape the area.
10. Undo materials (binder or adhesive) and secure the dressings.
Lift dressing off by touching the outside portion only. If it is
soiled, use forceps.
11. Clean the wound with antiseptic solution prescribed as
necessary.
a. Aseptic wound – start from incision (consider the
cleanest part) then away from it.
12. Apply the ointment thinly as prescribed, if any on the wound
and on the skin if drainage is present.
13. Cover the wound with sterile dressings and secure in place with
adhesive applied at edges.
14. Arrange client’s clothing and keep him/her comfortable.
15. Clean and return all equipments used.
16. Documentation: Record and chart time, dressing appearance of
wound with amount and character of drainage (if any),
observation, treatment such as removal or insertion of drains,
packing, etc.
C. ATTITUDE- 10%
17. Shows responsibility by having a complete set of equipment
needed in the activity and shows interest in doing the
procedure.
18. Displays courtesy and consideration in acknowledging
criticisms and suggestions by the Clinical Instructor.
19. Demonstrates integrity by doing the skill honestly, competently
and completely.
TOTAL

A. Knowledge - Total score / Total no of items x 60 + 40 = _____x .3= ______________

B. Skills - Total score / Total no of items x 60 + 40 = _____x .6= ______________

C. Attitude - Total score / Total no of items x 60 + 40 = _____x .1= ______________

TOTAL = ___________________

Clinical Instructor’s Comments / Suggestions:

____________________________________________________________________________

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Students’ Comments / Suggestions:

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________________________________ _________________________
Student’s name & signature C.I.’s name & signature