Wound Care Checklist

PERFORMANCE EVALUATION TOOL
NCM 109 – CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS

(ACUTE AND CHRONIC)
DIRECTIONS:
● The evaluation tool will be discussed by the clinical instructor/s.
● During the discussion, the instructor/s may demonstrate the procedures or may use
video viewing for students’ orientation.
● The students should be given sufficient time to prepare for the return demonstration.
● The students will do the return demonstration based on the checklist given.
● The following rating scale shall be used in grading student’s performance:
2 points - able to perform

Perform the procedure safely and accurately in a very consistent and
independent manner without supportive assistance from the instructors.
Perform a difficult action quickly and skillfully
Spends minimal time on task
Focuses on client while giving care
1points - able to perform with assistance

Perform the procedure safely and accurately with frequent guidance and
supervision from the instructor.
Demonstrate incomplete skills in some part of the procedure.
Takes longer time to complete the procedure.
0 point - unable to perform

Unable to perform procedure even under close supervision of guidance
Require continuous, supportive and directive cues
Performs in unskilled manner
● At the end of each laboratory session, the instructor/s will give remarks based on the
student’s performance in accordance to the procedures indicated.
PERFORMANCE EVALUATION TOOL
NCM 109 – CARE
OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
NAME OF STUDENT: _____________________
Block #______
PROCEDURE: WOUND CARE (DRY DRESSING)
N PURPOSE/S: 2 1 0 REMARKS
O
1 To promote healing.
2 To prevent infection
3 ASSESSMENT RATIONALE
To ensure the right
4 Doctor’s order order is carried out at
the right time.
5 Client’s level of consciousness Determine client’s ability
and level of knowledge and to follow instructions.
understanding
Ask the client about allergy to Helps the nurse to
6 latex or Chlorhexidine select another cleansing
gluconate or any cleansing solution and materials.
solution.
Completeness of the materials To save the nurse’s
7 needed time and energy.
8 Procedure/Implementation RATIONALE
1.Identify the client, explain >Ensures correct
9 the procedure, why it is patient and promotes
necessary and how she can client’s cooperation and
cooperate. participation during the
procedure.
2.Wash hands and wear clean Reduces the
10 gloves and other Personal transmission of
Protective Equipment. microorganisms.
>Saves time and effort.
11 3.Gather the necessary >Avoids leaving the

materials and arrange at the client unattended to
client’s bedside table. retrieve missing
materials.
>Promotes client’s
safety.
12 a.Clean exam gloves
b.Container for proper
13
disposal of soiled dressing
N PURPOSE/S: RATIONALE 2 1 0 REMARKS
O
14 c.Sterile 4x4 gauze
15 d.Washcloth (optional)
16 e.Abdominal pads (optional)
17 4.2 inch tape (foam or paper)
4.Close the door and draw the >Promotes client’s
18 curtain divider. privacy
5.Raise the bed to its’ Helps the nurse to work
19 comfortable level and lower at ease.
the siderails where you will >Prevents strain at the
work and put away call light. nurse’s back.
6.Remove gloves, do hand >Prevents spread of
20 rub and wear another clean microorganism.
gloves.
Dressing and soiled
21 7.Remove dressing and place gloves with body fluids
in appropriate receptacle. are considered
contaminated and
subject to biohazard
disposal in correct
manner per institution
protocol
8.Removed soiled gloves with
22 contaminated surfaces inward
and discard in appropriate
receptacle
9.Assess the appearance of
the undressed wound bed for >Helps the nurse to
23 healing as well as signs of identify what nursing
infection and delayed healing management is needed.
such as pain, redness,
inflammation around the
surrounding tissue, type and
volume of exudate
>Reduces transmission
24 10.Do hand rub and wear of microorganisms
clean gloves. >Dressing changes are
considered to be clean
procedures once the
initial dressing has been
removed if the skin
margins are well
approximated
O
11. If inspection of wounds
25 revealed delayed
epithelialization, don sterile
gloves
12.Clean the skin around the Dry blood or drainage
26 incision if needed with can act as a medium for
moistened gauze. bacterial growth
13.Cleanse the incision if
needed with gauze or cotton
27
tipped applicator moistened
with saline (or with solution
ordered by the physician or
qualified practitioner)
14.Used applicators should
28 not be reintroduced into the
cleansing solution
15.Apply the gauze dressing No touch technique
29 using the “no touch” prevents the
technique; grasp just the edge contamination of the
of the dressing, fold if needed, dressing
and apply to the wound.
16.Secure with tape (or
30 tubular mesh for client with
sensitivity to tape)
17.Initial the dressing and This maintains the
31 indicate the date and time it record of the dressing
was changed. change for the next
nurse
18.Optional: An abdominal >To promote client’s
32 pad may be applied over the comfort
gauze dressing if needed >For absorption of
exudate
19.Lower the bed. Raise the >Promotes client’s
33 side rails and put the call light safety.
within the client’s reach.
20.Dispose all soiled >Prevents spread of
34 dressings properly according disease and bacteria
to hospital policy.
>Maintains orderliness
35 21.Rearrange reusable of materials and the
materials in its proper places. environment.

O
22.Remove gloves and other >Prevents spread of
36 PPE, discard properly and do microorganisms.
hand washing.
23.Conduct client and family To prepare the client
37 education about the dressing; and family for proper
which may include the wound care as they
dressing technique to the prepare of going home.
client and family
24.Document the procedure >Provides record of the
38 and other important findings client’s care and serves
on the client’s chart. as a baseline for further
management.
> Refer any abnormal findings
to the attending physician.
TOTAL SCOR/GRADE: __________
Student’s Signature: ________________ Instructor’s Signature:

______________
Date: _______
Comments/Suggestions:
__________________________________________________
______________________________________________________________________
______________________________________________________________________
Reference: Daniles, Grendell, Wilkins (2010) Fundamentals of Nursing. Nursing Human

Functions. Volume 2. ESP Printers, Inc.Philippines

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PERFORMANCE EVALUATION TOOL

NCM 109 – CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS

2 points - able to perform

1points - able to perform with assistance

0 point - unable to perform

PROCEDURE: WOUND CARE (DRY DRESSING)

>Saves time and effort.

11 3.Gather the necessary >Avoids leaving the

N PURPOSE/S: RATIONALE 2 1 0 REMARKS

TOTAL SCOR/GRADE: __________

Student’s Signature: ________________ Instructor’s Signature:

Reference: Daniles, Grendell, Wilkins (2010) Fundamentals of Nursing. Nursing Human

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