COLLEGE OF NURSING

Valenzuela City

PROGRAM Bachelor of Science in Nursing STUDENT NAME

YEAR AND SECTION
NCMA217 RLE SKILLS LABORATORY
COURSE Care of Mother, Child and Adolescent INSTRUCTOR
(Well Client)
DATE

PROCEDURE : PROVIDING GENITAL CARE FOR MALE PATIENT

EXPECTED OUTCOME : The student should be able to provide perineum and genital care for male patient correctly.
ASSESSMENT TASK : Return Demonstration

Exceptional Good Average Poor

Assessment Dimension SCORE
(3) (2) (1) (0)
1. Assess client’s self-care Performed the Performed but Performed with Failed to perform
abilities. procedure accurately needs minimal slight difficulty, the procedure
with evident ease supervision needs supervision
without supervision most of the time
2. Do hand washing. Observed principle of Hand washing was Hand washing was Hand washing
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. Explain Explained the Explained the Explained the Failed to explain
procedure. Provide procedure to the procedure but lacks procedure but in an the procedure
privacy. client and significant details unclear manner
others clearly
5. Place water proof pad Gathered the Gathered the Gathered materials Failed to
under the client’s materials needed materials with little with more time gathered all the
buttock. completely time preparation preparation materials
needed
6. Place client in a supine Demonstrated the Demonstrated the Demonstrated the Failed to perform
position with legs procedures with ease procedure with little procedure with the procedure
slightly flexed and hips errors some errors
slightly externally
rotated.
7. Fold the top bed linen Performed the Performed but Performed with Failed to perform
to the foot of the bed. procedure accurately needs minimal slight difficulty, the procedure
with evident ease supervision needs supervision
without supervision most of the time
8. Cover client’s body and Performed the Performed but Performed with Failed to perform
leg with the bath procedure accurately needs minimal slight difficulty, the procedure
blanket with evident ease supervision needs supervision
without supervision most of the time
9. Drape legs by tucking Performed the Performed but Performed with Failed to perform
the bottom corners of procedure accurately needs minimal slight difficulty, the procedure
the bath blanket under with evident ease supervision needs supervision
the inner side of the without supervision most of the time
legs.

10. Bring the middle Performed the Performed but Performed with Failed to perform
portion of the base of procedure accurately needs minimal slight difficulty, the procedure
the blanket up over the with evident ease supervision needs supervision
pubic area. without supervision most of the time
11. Put on clean gloves. Performed the Performed but Performed with Failed to perform
procedure accurately needs minimal slight difficulty, the procedure
with evident ease supervision needs supervision
without supervision most of the time
12. Wash and dry the penis Performed the Performed but Performed with Failed to perform
using firm strokes. If procedure accurately needs minimal slight difficulty, the procedure
client is uncircumcised, with evident ease supervision needs supervision
retract the prepuce to without supervision most of the time
expose the glans penis
for cleaning. Replace
the foreskin after
cleaning the glans
penis.
13. Note any signs of Performed the Performed but Performed with Failed to perform
inflammation, procedure accurately needs minimal slight difficulty, the procedure
excoriation or swelling with evident ease supervision needs supervision
especially in the scrotal without supervision most of the time
folds.
14. Clean and dry upper Performed the Performed but Performed with Failed to perform
inner thighs. procedure accurately needs minimal slight difficulty, the procedure
with evident ease supervision needs supervision
without supervision most of the time
15. Assist client to turn Performed the Performed but Performed with Failed to perform
onto side facing away procedure accurately needs minimal slight difficulty, the procedure
from you. with evident ease supervision needs supervision
without supervision most of the time
16. Clean and dry between Performed the Performed but Performed with Failed to perform
buttocks paying procedure accurately needs minimal slight difficulty, the procedure
particular attention to with evident ease supervision needs supervision
the anal area and without supervision most of the time
posterior folds of the
scrotum.
17. Dispose linens and Performed the Performed but Performed with Failed to perform
other soiled materials procedure accurately needs minimal slight difficulty, the procedure
properly. with evident ease supervision needs supervision
without supervision most of the time
18. Wash hand. Document Washed hands and Washed hands and Washed hands but Washed hands
procedure including documented the some of the details most of the details but
unusual findings. information about of procedure were of the procedure documentation
the procedure not documented. were not was not done.
properly and documented
completely.

OVERALL SCORE: ________________

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

_________________________________________
Signature Over Printed Name of Clinical Instructor