2022-2023

CON
Wesleyan University Philippines
2022-2023
 WESLEYAN
AN AUTONOMOUS METHODIST UNIVERSITY

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

PERFORMANCE EVALUATION TOOL

NCM 109 – CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)
HIP AND SITZ BATH
DIRECTIONS:
● The evaluation tool will be discussed by the clinical instructor/s.
● During the discussion, the instructor/s may demonstrate the procedures or may use
video viewing for students’ orientation.
● The students should be given sufficient time to prepare for the return demonstration.
● The students will do the return demonstration based on the checklist given.
● The following rating scale shall be used in grading student’s performance:

DONE- able to perform

Perform the procedure safely and accurately in a very consistent and
independent manner without supportive assistance from the instructors.
Perform a difficult action quickly and skillfully
Spends minimal time on task
Focuses on client while giving care

NOT DONE- unable to perform

Unable to perform procedure
Require continuous, supportive and directive cues
Performs in unskilled manner

● At the end of each laboratory session, the instructor/s will give remarks based on the
student’s performance in accordance to the procedures indicated.
 WESLEYAN
AN AUTONOMOUS METHODIST UNIVERSITY

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

PERFORMANCE EVALUATION TOOL

NCM 109 – CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)
NAME OF STUDENT: _____________________
Block #______

PROCEDURE: HIP AND SITZ BATH

DONE NOT DONE

1. Secures written order. Wash hands.

2. Explains procedure and purpose of treatment to the client

3. Assembles equipment: Sitz tub or big deep basin, rubber

ring, pitchers of hot and tap water, ice cap, hot water bag,
blankets, bath towels, newspaper, dressing tray, patient’s
gown, chair lined with blanket.

4. Provides for privacy. Closes windows, electric fan or aircon

to avoid draft and chilling

5. Lines floor with newspaper. Places rubber ring inside sitz

tub.

6. Fills sitz tub with 1/3 full of hot and tap water (40-460
C/105-1150 F) and lines its rim with bath towel. Positions
sitz tub near the bed.

7. Removes perianal dressings if present. Instructs client to

void. Does perianal care

8. Assists client to sit up on side of bed. Takes pulse rate and

respiratory rate.

9. Drapes blanket around client’s shoulders and removes

gown from underneath

10. Assists client to sit slowly in the tub with midthigh

immersed up to iliac crest and/or umbilicus. Arranges the
blanket to enclose the tub
 WESLEYAN
AN AUTONOMOUS METHODIST UNIVERSITY

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

11. Places ice cap over the head

12. Apply a hot water bag over the feet. Observes for burn
precaution

13. Observes clients closely for untoward reactions during the

duration of treatment usually 15-20 minutes or as
ordered. Takes pulse rate and respiratory rate.

14. Assists the client out of the tub to sit on a towel lined
chair.

15. Dries client and assists to put on new gown.

16. Assists client back to bed. Redresses the wound if

indicated.

17. Retain an ice cap and hot water bag for 30 minutes more.

18. Cleans and returns used equipment. Keeps the room

orderly.

19. Wash hands.

20. Documents: time and duration of procedure, client’s

response, wound status if present.

TOTAL=20 POINTS

REMARKS:__________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Expected level of performance
16 TO 20 items done: PASS
Below 15 items done: Repeat Procedure to PASS

Student’s Signature:_______________ Instructor’ Signature________________

Date:_____ Date:__________