MUMMYING PROCEDURE RUBRIC

Name _____________________________________________ Section ___ Date_________Score_______________

CRITERIA EXCELLENT VERY SATISFACTORY POOR SCORE
4 SATISFACTORY 2 1
3
1. Demonstration of the following Demonstrated Demonstrated five Demonstrated three Demonstrated
preliminary activities: all preliminary of preliminary to four of one to two of
 Gather linen or wrap. activities activities preliminary preliminary
To save time. activities activities
 Courtesy to significant other.
Integrates value of character
development.
 Introduction of self to
significant other.
Client’s right to know who is
caring for her child.
 Client identification.
Prevents error.
 Establish rapport, explain
procedure, and identify its
purpose to significant other.
Allays fear and anxiety thus
gaining significant other’s
cooperation.
 Assess infant’s development.
To note for unusual findings.

2. Observation of proper infection EXCELLEN VERY SATISFACTORY POOR

control and safety measures T SATISFACTORY Observed one to Observed
 Handwashing (before and Observed all Observed three to two of proper none of
after procedure) tasks for four of proper infection control proper
To prevent the transmission proper infection control and safety measures infection
of microorganism. infection and safety control and
 Identify environmental control and measures safety
hazards. safety measures
To prevent undue injury to measures
the infant.
 Ensure cleanliness and
sanitation of linen or wrap
that will be used.
The material can be a source
of infection.
 Ensure that the room is
warm and draft-free .
To prevent cold stress.
 Proper cleaning and disposal
of things used.
To prevent the transmission
 of microorganism and for
environmental protection.

.
3. Accuracy and completeness in EXCELLEN VERY SATISFACTORY POOR
performing procedure T SATISFACTORY Performed entire Not able to
Mummy infant as follows: Performed Performed entire procedure with perform entire
 Head and Neck Exposed entire procedure with much inaccuracy procedure
- Get and fold clean linen procedure minimal accuracy and incompleteness accurately and
or wrap. accurately but completely completely
and
- Place linen or wrap
completely
under infant.
- Fold one corner over
arm, across chest,
around other arm, and
under back.
- Fold bottom up.
- Fold second corner over
top of infant and around
body firmly.
- Pin or hold in place.
 Chest and Abdomen
Exposed
- Obtain triangle – folded
clean linen or wrap.
- Place linen or wrap
under infant.
- Wrap one corner over
arm and under back.
- Repeat for other side.
- Wrap end securely
around legs.
- Fold bottom point up
over feet.
- Pin or tuck bottom edge
over arm.
4. Confidence EXCELLEN VERY SATISFACTORY POOR
T SATISFACTORY Performed entire Not able to
Performed Performed entire procedure with little perform entire
entire procedure with confidence procedure
procedure moderate with
with great confidence confidence
confidence
5. Timing (at least 30 minutes) EXCELLEN VERY SATISFACTORY
T SATISFACTORY Performed entire POOR
Performed Performed entire procedure with 10 Performed the
entire procedure with 5 minutes excess on entire
procedure minutes excess on the allotted time procedure
within the the allotted time with 15
 allotted time minutes or
more excess of
the allotted
time.
6. Documentation EXCELLEN VERY SATISFACTORY POOR
 Circulation in extremities T SATISFACTORY One to two of the Documentatio
distal to restraint All Three to four of the documented data n incomplete,
 Color of skin under restraint documented documented data were complete, inaccurate,
 Comfort and safety data were were complete, accurate, and and not
 Type of material used and complete, accurate, and concise concise
accurate, and concise
time applied
concise
 Other significant findings
TOTAL

Perfect Score: 24 points

Range of Scores:
22 – 24 --------------------------------------- Excellent
18 - 21 --------------------------------------- Very Satisfactory
14 – 17 --------------------------------------- Satisfactory
10 – 13 --------------------------------------- Poor

Assessed by:
___________________________________
Name and Signature of RLE Instructor