Far Eastern University

Institute of Nursing

PERFORMANCE EVALUATION TOOL FOR

OPEN GLOVING

NAME: ____________________________________________________________ SCORE: _____________

SECTION / GROUP NO: __________________ DATE: _______________ FACULTY: _____________
Direction: Rate the learners based on the competencies listed below.

NUMERICAL RATING DESCRIPTION

3 Performs expected competencies in a very consistent manner.
2 Performs expected competencies in a moderately consistent manner.
1 Performs expected competencies in a rarely consistent manner.
0 Does not perform expected competencies.

PROCEDURE 0 1 2 3 REMARKS

1. State purposes of gloving.

2. Assemble necessary materials for gloving.

3. Perform medical hand washing.

4. Open the glove pack.

5. Place the open glove pack so that the fingers are pointing upwards.

6. Pick up the right glove with the left hand, taking care only to handle the
inner surface of the turned down cuff.

7. Pull the glove onto the right hand, hooking the thumb underneath the cuff
as the hand is pushed inside; pull the cuff to cover the wrist

8. Next pick up the left glove underneath the folded cuff with the gloved
fingers of the right hand.

9. Pull the glove onto the left hand, hooking the rim over the thumb to enable
to pull the cuff to cover the wrist

1
10. Remove soiled gloves by pulling the first glove completely off by everting
or rolling the glove inside out.

11. Continue to hold the everted removed glove by the fingers of the remaining
gloved hand.

12. Place the first two fingers of the bare hand inside the cuff of the second
glove.

13. Pull the second glove off to the fingers by turning it inside out. This pulls
the first glove inside the second glove.

14. After Care: Dispose soiled gloves in yellow trash bin (infectious bin)

Total Score ___÷ 42 X 100 = _________________

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Signature of Student Signature of Faculty