Ateneo de Zamboanga University

College of Nursing
PERFORMANCE EVALUATION CHECKLIST
BAG TECHNIQUE

NAME: _____________________________ DATE PERFORMED: _________________

YEAR & SECTION: ___________________________
Legend (Rating Criteria):
5 – Expert (student performs all tasks proficiently and independently).
4 – Competent (student performs efficiently in an effective and efficient manner).
3 – Progress Acceptable (performance is usually effective and but not always).
2 – Needs Improvement (progress in performance is too slow to judge satisfactorily; task performance is not
most of the time).
1 – Progress Unacceptable (no progress in performance has been demonstrated, and or performance is
consistently ineffective and inefficient).
Purposes:
1. To minimize if not prevent the danger of the spread of any infection.
2. To work efficiently and rapidly using technique as a tool to save time and effort.
Bag Technique
 The bag technique is a tool by which the nurse, during her visit will enable her to perform a nursing procedure
with ease and deftness, to save time and effort, with the end view of rendering effective nursing care to clients.
 The public health bag is an essential and indispensable equipment of a public health nurse which she has to
carry along during her home visits. It contains basic medications and articles which are necessary for giving
care.
Principles
• Performing the bag technique will minimize, if not, prevent the spread of any infection.
• It saves time and effort in the performance of nursing procedures.
• The bag technique can be performed in a variety of ways depending on the agency’s policy, the home situation,
or as long as principles of avoiding transfer of infection is always observed.
Preparation
1. Assemble the equipment of PHN bag
PROCEDURE 1 2 3 4 5
1. Upon arrival at the patient’s home, place the bag on the table lined with a clean
paper. The clean side must be out and the folded part, touching the table. Put the
bag’s handles or strap beneath the bag.
2. Ask for a basin of water or a glass of drinking water it faucet is not available. Put
this outside the work area.
3.
Open the bag and take out the towel and soap.
4.
Wash hands using soap and water. Wipe to dry.
5.
Take out the apron from the bag and put on with right side out.
6.
Put out all the necessary articles needed for the specific care.
7.
Close the bag and put it on in one corner of the working area.
8.
Proceed in performing the necessary nursing care and treatment.
9.
After giving the treatment, clean all things that were use &perform hand washing.
10. Open the bag and return all things that were used in their proper places after
cleaning all the things that were used and perform hand washing.
11. Remove apron, folding it away from the person, the soiled side in and the clean
side out. Place it in the bag.
12.
Fold the lining, place it inside the bag and close the bag.
13. Take and record and have a talk with the mother. Write down all the necessary data
that were gathered, observations, nursing care and treatment rendered.
14. Make appointment for the next visit (either home or clinic) taking note of the date
and time.
TOTAL

__________________________
Clinical Instructor
(Sign over printed name)

Arrangement of Content of PHN Bag 1 2 3 4 5

A.
TOP POCKET

1. Gloves (Sterile)

2. Waste Receptacle

3. Plastic Bag
B.
FRONT OF BAG (Left to Right)

4. Oral Thermometer

5. Rectal Thermometer

6. Axillary Thermometer

7. Disposable Syringes with Needles

C.
Left Rear (Rear to Front)

8. Medicine Glass

9. Rubber Pump/Suction

10. Baby Weighing Scale

11. Tourniquet

12. Tongue Depressor

D.
Back of the Bag: (from Left to Right)
13. Sterile Cotton Balls Soaked in
a. Betadine Solution
b. 70% Alcohol
c. Hydrogen Peroxide
14. Lysole Solution

15. Spirit of Ammonia (optional)

16. Benedict’s & Acetic Acid Solutions

E.
Right Rear (Rear to Front)

17. Two Test Tubes & Test Tube Holder

18. Three Medicine Droppers

19. Match

20. Alcohol Lamp with Denatured Alcohol

F.
Center of the Bag (Bottom to Top)

21. Kidney Basin

 Cloth Bag with the following:
22. Kelly Straight
23. Kelly Curve

24. Umbilical Scissors

25. Thumb Forceps

26. Tissue Forceps

27. Cord Clamp

 Cloth Bag with:
28. Sterile OS
29. Bandage Scissors

30. Adhesive Bandage/Plaster

31. Cotton Applicator (Individually Wrapped)

Center of the bag (outside the cloth bag)

32. Two Hand Towels (White)

33. Soap Dish with Soap

34. Apron (white)

TOTAL
*BP apparatus and stethoscope are carried separately and are never placed in the bag

_________________________
Clinical Instructor