PROGRAM Bachelor of Science in Nursing STUDENT NAME

YEAR AND SECTION

COURSE NCMA 217 INSTRUCTOR
DATE
PROCEDURE : PROVIDING PERINEAL AND GENITAL CARE FOR FEMALE PATIENT
EXPECTED OUTCOME : The student should be able to provide perineal and genital care for female patient
correctly.
ASSESSMENT TASK : Return Demonstration

Exceptional Good Average Poor

Assessment Dimension SCORE
(3) (2) (1) (0)
1. Assess client’s self- Performed the Performed but Performed with slight Failed to
care abilities. procedure needs minimal difficulty, needs perform the
accurately with supervision supervision most of procedure
evident ease the time
without supervision
2. Do handwashing. Observed principle Hand washing was Hand washing was Hand washing
of medical hand done with minimal done with maximal was not done
washing error error
3. Prepare materials Gathered the Gathered the Gathered materials Failed to
materials needed materials with little with more time gathered all the
completely time preparation preparation materials
needed
4. Identify client. Explained the Explained the Explained the Failed to explain
Explain procedure. procedure to the procedure but lacks procedure but in an the procedure
Provide privacy. client and significant details unclear manner
others clearly
5. Place water proof Performed the Performed but Performed with slight Failed to
pad under the procedure needs minimal difficulty, needs perform the
client’s buttock. accurately with supervision supervision most of procedure
evident ease the time
without supervision
6. Place client in back- Demonstrated the Demonstrated the Demonstrated the Failed to
lying position with procedures with procedure with little procedure with some perform the
the knee flexed and ease errors errors procedure
spread well apart.
7. Fold the top bed Performed the Performed but Performed with slight Failed to
linen to the foot of procedure needs minimal difficulty, needs perform the
the bed. accurately with supervision supervision most of procedure
evident ease the time
without supervision
8. Cover client’s body Performed the Performed but Performed with slight Failed to
and leg with the procedure needs minimal difficulty, needs perform the
bath blanket accurately with supervision supervision most of procedure
evident ease the time
without supervision
9. Drape legs by Performed the Performed but Performed with slight Failed to
tucking the bottom procedure needs minimal difficulty, needs perform the
corners of the bath accurately with supervision supervision most of procedure
blanket under the evident ease the time
inner side of the without supervision
legs.
10. Bring the middle Performed the Performed but Performed with slight Failed to
portion of the base procedure needs minimal difficulty, needs perform the
of the blanket up accurately with supervision supervision most of procedure
over the pubic area. evident ease the time
without supervision
11. Place client on a Performed the Performed but Performed with slight Failed to
bedpan. procedure needs minimal difficulty, needs perform the
accurately with supervision supervision most of procedure
 evident ease the time
without supervision
12. Put on clean gloves. Performed the Performed but Performed with slight Failed to
procedure needs minimal difficulty, needs perform the
accurately with supervision supervision most of procedure
evident ease the time
without supervision
13. Clean the perineal Performed the Performed but Performed with slight Failed to
area. First the procedure needs minimal difficulty, needs perform the
meatus down then accurately with supervision supervision most of procedure
labia minora and evident ease the time
majora. Use the without supervision
figure of seven
strokes. Use new
cotton balls / gauze
every stroke.
14. Rinse well. Dry Performed the Performed but Performed with slight Failed to
perineum procedure needs minimal difficulty, needs perform the
thoroughly. Pay accurately with supervision supervision most of procedure
particular attention evident ease the time
to the folds without supervision
between the labia.
15. Note any signs of Demonstrated the Demonstrated the Demonstrated the Failed to
inflammation, procedures with procedure with little procedure with some perform the
swelling between ease errors errors procedure
the labial folds. Note
for excessive
secretions from the
orifices and
presence of odors.
16. Assists client to turn Performed the Performed but Performed with slight Failed to
on his side facing procedure needs minimal difficulty, needs perform the
away from you. accurately with supervision supervision most of procedure
Clean between evident ease the time
buttocks. Dry the without supervision
area well.
17. Dispose all linens Performed the Performed but Performed with slight Failed to
and other soiled procedure needs minimal difficulty, needs perform the
material properly. accurately with supervision supervision most of procedure
evident ease the time
without supervision
18. Remove glove. Do Washed hands and Washed hands and Washed hands but Washed hands
handwashing. documented the some of the details most of the details of but
Document information about of procedure were the procedure were documentation
procedure. Note the procedure not documented. not documented was not done.
unusual findings. properly and
completely.

OVERALL SCORE: ________________

Target raw score: 41 out of 54. If raw score is less than 41, repeat the demonstration.

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FACULTY SIGNATURE OVER PRINTED NAME