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Checklist IntraOperative Competency Circulating 2022

This document contains a performance evaluation form for a circulating nurse achieving intra-operative care competencies. The form evaluates the nurse across 11 competency domains with specific criteria within each domain. It shows the desired rating for each criterion as well as the nurse's actual self-rated performance. The clinical instructor, clinical coordinator, dean, and nursing board have certified that the evaluation is true and correct. The total score achieved was 65.

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Russel Pama
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146 views

Checklist IntraOperative Competency Circulating 2022

This document contains a performance evaluation form for a circulating nurse achieving intra-operative care competencies. The form evaluates the nurse across 11 competency domains with specific criteria within each domain. It shows the desired rating for each criterion as well as the nurse's actual self-rated performance. The clinical instructor, clinical coordinator, dean, and nursing board have certified that the evaluation is true and correct. The total score achieved was 65.

Uploaded by

Russel Pama
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UNIVERSITY OF ST.

LA SALLE
College of Nursing
La Salle Avenue, Bacolod City, 6100 Philippines, (034) 434-4010, [email protected]

SUMMARY PERFORMANCE EVALUATION ACHIEVING


INTRA-OPERATIVE CARE COMPETENCY
CIRCULATING NURSE
In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Signature over Printed Name of Student:

DESIRED ACTUAL
INTRA-OPERATIVE CARE COMPETENCIES
RATING RATING
I. SAFE AND QUALITY NURSING CARE (SQC)
1. Utilizes the nursing process in the care of OR client.
a. Obtains comprehensive client’s information by checking complete 4
accomplishment of the preoperative checklist/client’s chart.
b. Identifies priority needs of the client at the Operating Room 4
c. Provides needed nursing interventions based on identified needs 4
d. Monitors client’s responses to surgery 2
2. Promotes safety and comfort of patients inside the OR 2
3. Performs surgical count accurately with the scrub nurse 2
4. Performs the functions of the circulating nurse
2
a. Anticipates the needs of the surgical team
b. Sets up the OR room and needed equipment 2
c. Receives client for surgery/endorses client post-operatively 2
d. Assists in skin preparation and draping of client 2
5. Administers medications and other health therapeutics safely 2
II. MANAGEMENT OF RESOURCES AND ENVIRONMENT (MRE)
1. Organizes work load to facilitate timely patient care 4
2. Utilizes adequate and appropriate resources to support the OR team 2
3. Ensures functionality of OR resources 2
4. Maintains a safe environment at the OR by observing the principles of asepsis 2
III. HEALTH EDUCATION (HE)
1. Implements appropriate health education activities to client based on needs
2
assessment
IV. LEGAL RESPONSIBILITIES (LR)
1. Adheres to legal and institutional protocols regarding informed consent 2
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the rights of the OR client 2
2. Accepts responsibility and accountability for own decisions and actions as an
2
OR nurse
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Performs OR functions according to professional standards 4
2. Possesses positive attitude towards learning surgical and OR-related
2
knowledge and skills
VII. QUALITY IMPROVEMENT (QI)
1. Participants in quality improvement activities related to infection control and
2
successful OR operations
2. Identifies and reports variances in sterility and other OR activities 2
VIII. RESEARCH (R)
1. Disseminates results of OR-related research findings to clinical group and
2
other member of the OR tem as appropriate
IX. RECORDS MANAGEMENT (RM)

Board of Nursing
DESIRED ACTUAL
INTRA-OPERATIVE CARE COMPETENCIES
RATING RATING
1. Maintain accurate and updated documentation of patient care 2
X. COMMUNICATION (Comm)
1. Establishes rapport with patients, significant others and members of the health
1
team
2. Uses appropriate information mechanisms to facilitate communication inside
2
the OR and with other departments in the hospital
XI. COLLABORATION AND TEAMWORK (CTM)
1. Collaborates plan of care with other members of the health team 2
TOTAL SCORE 65

Certified True and Correct:

Clinical Instructor Clinical Coordinator


(Signature over Printed Name) (Signature over Printed Name)
License Number: License Number:
PRC Card – Validity Date: PRC Card – Validity Date:

DEAN Academic Year Graduated


(Signature over Printed Name)
License Number:
PRC Card – Validity Date:

Board of Nursing

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