OUR LADY OF FATIMA UNIVERSITY
COLLEGE OF NURSING –Quezon City Campus
PROGRAM
Bachelor of Science in Nursing
Student Name
COURSE
NCMA 217 RLE
MATERNAL AND CHILD
HEALTH NURSING
Year and Section
Instructor
Date
PROCEDURE
EXPECTED OUTCOME
ASESSMENT TASK
Assessment Dimension
1.
Explain the
procedure
2.
Prepare
equipment
3.
Ask the client to
get a mid-stream
catch urine and
place it in a
receptacle
4.
Perform hand
washing
5.
Put on clean
gloves
6.
Fill inthe test tube
with 5ml of the
benedict solution
7.
Heat the solution
over the flame
wait until it boils
8.
Add 3-5 drops of
the urine and
allow it to boil
together with the
solution/mixture
9.
Leave the mixture
to cool at room
temperature
10. Interpret the
color and the
result of the test
: Benedict’s Test
: The student should be able to perform benedict’s test to client
: Return demonstration
Exceptional
(4)
Explained the procedure
to the client and
significant others clearly
Gathered materials
needed
Performed the
procedure accurately
with evident ease
without supervision
Observed principle of
medical hand washing
Performed the
procedure accurately
with evident ease
without supervision
Performed the
procedure accurately
with evident ease
without supervision
Performed the
procedure accurately
with evident ease
without supervision
Performed the
procedure accurately
with evident ease
without supervision
Performed the
procedure accurately
with evident ease
without supervision
Performed the
procedure accurately
with evident ease
without supervision
Good
(3)
Explained the
procedure but
lacks details
Gathered materials
with little time
preparation
Performed but
needs minimal
supervision
Average
(2)
Explained the
procedure but in
an unclear manner
Gathered materials
with more time
preparation
Performed with
slight difficulty,
needs supervision
most of the time
Hand washing was
done with minimal
error
Performed but
needs minimal
supervision
Hand washing was
done with maximal
error
Performed with
slight difficulty,
needs supervision
most of the time
Performed with
slight difficulty,
needs supervision
most of the time
Performed with
slight difficulty,
needs supervision
most of the time
Performed with
slight difficulty,
needs supervision
most of the time
Hand washing
was not done
Performed with
slight difficulty,
needs supervision
most of the time
Performed with
slight difficulty,
needs supervision
most of the time
Failed to perform
the procedure
Performed but
needs minimal
supervision
Performed but
needs minimal
supervision
Performed but
needs minimal
supervision
Performed but
needs minimal
supervision
Performed but
needs minimal
supervision
Poor
(1)
Failed to explain
the procedure
Failed to gather
all the materials
needed
Failed to perform
the procedure
Failed to perform
the procedure
Failed to perform
the procedure
Failed to perform
the procedure
Failed to perform
the procedure
Failed to perform
the procedure
SCORE
11. Give health
teaching to the
client
12. Aftercare of the
materials used
13. Remove the
gloves
14. Perform hand
washing and
document the
procedure done
Performed the
procedure accurately
with evident ease
without supervision
Performed the
procedure accurately
with evident ease
without supervision
Performed the
procedure accurately
with evident ease
without supervision
Washed hands and
documented the
information about the
procedure properly and
completely.
Performed but
needs minimal
supervision
Performed but
needs minimal
supervision
Performed but
needs minimal
supervision
Washed hands and
some of the details
of procedure were
not documented.
Performed with
slight difficulty,
needs supervision
most of the time
Performed with
slight difficulty,
needs supervision
most of the time
Performed with
slight difficulty,
needs supervision
most of the time
Washed hands but
most of the details
of the procedure
were not
documented
Failed to perform
the procedure
Failed to perform
the procedure
Failed to perform
the procedure
Washed hands
but
documentation
was not done.
SCALE:
3 – (EXCEPTIONAL) Works competently and independently at all times
2 – (GOOD) Requires minimum guidance and supervision
1 – (AVERAGE) Requires frequent guidance and supervision
0 – (POOR) Requires close guidance and supervision most of the time
OVERALL SCORE: ________________
Target raw score is 32 out of 42. If raw score is less than 32, repeat the demonstration.
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FACULTY SIGNATURE OVER PRINTED NAME
STUDENT NURSE SIGNATURE OVER PRINTED NAME