Far Eastern University

Institute of Nursing

STUDENT PERFORMANCE EVALUATION TOOL

COLOSTOMY CARE

Name:_____________________________ Sec/Group No:________________ Date:________________

Area:______________________________ Faculty:__________________ Concept:___________________
DIRECTION: Rate the learner based on the competencies listed below
KEY:
3 – Very Good Performs expected competencies in a very consistent manner.
2 – Satisfactory Performs expected competencies in a moderately consistent manner.
1 – Needs Improvement Performs expected competencies in a rarely consistent manner.
0 – Poor Does not perform expected competencies.
CRITERIA SCORE
A. ATTENDANCE AND ATTITUDE
1. Report on time and attend to activities punctually
2. Display proper grooming and wears complete uniform
3. Behaves appropriately towards teachers, classmates and
clients
4. Accepts constructive criticism
B. PROCEDURE
1. Assist the client to a comfortable sitting or lying position
and expose only the stoma area
2. Don Gloves
3. Empty the pouch when 1/3 to ½ full & assess for the
consistency & amount of effluent
4. Remove the appliance and discard.
5. Using warm water and mild soap, clean the peristomal
skin and the stoma
6. Dry the area thoroughly by patting with a towel or cotton
swabs
7. Assess the stoma & peristomal skin. Place a piece of tissue
or gauze pad over the stoma, and change it as needed
8. Measure the size of the stoma by tracing a circle on the
backing of the skin barrier the same size as the stomal
opening. Cut out the traced stoma pattern to make an
opening in the skin barrier. Remove the backing to expose
the sticky adhesive side.
9. Remove the tissue or gauze pad on the stoma
10. Center the skin barrier over the stoma & gently press it
onto the skin, smoothing out any wrinkles or bubbles
11. Remove the air from the pouch

TOTAL SCORE =

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Signature of Student Signature of Faculty