POWER College

Department of Nursing
Cooperative Training Assessment Check List
Name student: --------------------------------------------------ID---------------------
Course title: - Provide Basic Nursing Care Unit Code HLT NUR3 05 1221
S.no Check list Remark
Wt Points
1. Identify causes of disease. 15
2. Discuss basic concept of anatomy and physiology of each system. 7
3. Identify available options for professional skill development 3
4. Develop strategies and care plan outlined based on procedure guide 5
5. Identify patient condition and purpose of care 5
6. Understood indication of procedures and contraindication. 7
7. Clean and tidy patient unit and equipment 3
8. Establish and maintain client provider relationship through appropriate language, and 8
recognize cultural, spiritual and religious backgrounds
9. Identify nursing care procedures and safety appliances 5
10. Identify procedures that need aseptic technique and clean techniques. 2
11. Insure verbal communication of patient before, intra and end of Procedure. 5
12. Use appropriate posture and handling techniques to reduce muscle load on exertion. 5
13. Check and record patient's vital signs. 15
14. Identify the need and apply patient safety and comfort devices 8
15. Identify appropriate hygienic care according to client needs 2
16. Perform patient transportation. 5
Total 100%
Evaluator
Name----------------------------------- Signature--------------
Course title: - Provide Palliative Care and Maintain Mortuary Service Unit Code HLT NUR3 08 1221
S.no Check list Remark
Wt Points
1. Identify and apply palliative approach to care 15
2. Identify needs of a person requiring end of life care. 15
3. Provide care after death 25
4. Receive bodies at mortuary 15
5. Prepare bodies for viewing 15
6. Maintain the mortuary environment 15
Total 100%
Evaluator
Name----------------------------------- Signature--------------
Course title: - Appling 5S procedures Module Code: IND WWT1 M14 0122
S.no Check list Remark
Wt Points
1. Develop understanding of quality system 15
2. Sort needed items from unneeded 15
3. Set workplace in order 20
4. Shine work area 15
5. Standardize activities 15
6. Sustain 5S system 20
Total 100%
Evaluator
Name----------------------------------- Signature--------------
Course title: - Provide community mobilization and health education Module code: HLT
NUR3 11 1121
s.n Check list weight Point
1. The effective transmission of accurate, useful, health related information to 15
community members.
2. Evaluation of behavioral change through heath education activities. 12
3. Identification of major community health problems. 12
4. Organizing community and available resources. 12
5. Measuring the use of health promotion, Advocacy and community mobilization. 15
6. Create a Supportive Environments for health promotion actions. 12
7. Implementation of effective approaches to health communication. 12
8. Taking Feedback from expert consultation and clients. 10
Total 100
Evaluator
Name----------------------------------- Signature--------------
Course title: - Apply Infection Prevention Techniques and Workplace OHS Module code: HLT
NUR3 02 1221
s.n Check list weight Point
1. Perform hand washing 20
2. Properly wearing and removing PPE 15
3. Conduct instrument processing 25
4. Manage waste appropriately 10
5. Clean environmental surfaces 10
6. Assess and control risks and hazards 20
Total 100
Evaluator
Name----------------------------------- Signature--------------
Course title: - Provide Basic First Aid and Emergency response Module code: HLT NUR3 03
1221
s.n Check list weight Point
1. Measure vital signs 30
2. Conduct adult, child and infant CPR 50
3. Use measures to control bleeding 10
4. Conduct first aid measures for fracture 10
Total 100
Evaluator
Name----------------------------------- Signature--------------
Course title: - Prepare and maintain beds Module code: HLT NUR3 04 1221
s.n Check list weight Point
1. Prepare area for bed making 15
2. Make bed 55
3. Leave bed ready for occupancy 20
4. Collect and manage Linen Stock at User Locations 10
Total 100
Evaluator
Name----------------------------------- Signature--------------
Course title: - Administer and Monitor Range of Medication Module code: HLT NUR3 07 1221
s.n Check list weight Point
1. Administer enteral Medication 20
2. Administer parenteral Medication 20
3. Administer suppository Medication 20
4. Administer topical Medication 20
5. Minimize potential risk to the safe administration of medications 20
Total 100
Evaluator
Name----------------------------------- Signature--------------
Course title: - Provide comprehensive family planning service Module code: : HLT NUR3 09 0122
s.n Check list weight Point
1. Provide COC & POP 20
2. Provide Depo provera 20
3. Provide implants 20
4. Provide IUCD 20
5. Provide detail counseling about family planning 20
Total 100
Evaluator
Name----------------------------------- Signature--------------
Course title: - Provide youth, adolescent and reproductive health service Module code: HLTNUR3
10 1121
s.n Check list weight Point
1. Provide RH service promotion and education 25
2. Identify RH problems 45
3. Diagnose and manage sexual transmitted infections 15
4. Register and document RH records 15
Total 100
Evaluator
Name----------------------------------- Signature--------------
Course title: - Provide wound Care Module code: HLT NUR3 06 1221
s.n Check list weight Point
1. Assess and identify wound 20
2. Contribute to planning appropriate care for the client with a wound 20
3. Perform wound care 20
4. Implement wound care 20
5. Evaluate the outcomes of nursing actions 20
Total 100
Evaluator
Name----------------------------------- Signature--------------
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