DAVAO DOCTORS COLLEGE

Gen. Malvar St., Davao City

NURSING PROGRAM

EVALUATIVE TOOL FOR NRG 203

PERFORMING HAND WASHING/HAND HYGIENE
NAME YEAR/SEC _____________ FINAL RATING:
DATE GRP.# ________

Directions: Each student is to be rated on performance in the return demonstration. Careful evaluation to be taken to compare the jobs
and tasks actually performed by the student nurse with those expected from the full performance of that assignment. Keeping the
guidelines in mind, please complete the Performance Evaluation Tool. Then determine an overall rating, giving weight to various
performance categories as appropriate to the particular assignment. Please indicate remarks in the space provided if needed. Overall
rating must be considered with the following standard definition.

5 4 3 2 1
PERFORMANCE (70%)
1 Checks for completeness of supply.
2 Stands in front of the sink with the uniform not touching the sink
3 Removes jewelry.
4 Turns on water and adjusts its force.
Wets the hands from wrist area with fingers pointing toward the bottom of the sink. Hands need
5
to be above elbows at all times.
6 Inspect condition of cuticles, hands, and forearms for abrasions, cuts, or open lesions.
7 With the bar or liquid soap, lathers hands thoroughly.
Washes hands and wrists for about 15-20 seconds with firm rubbing and circular motions, rub
8
palm to palm.
9 Interlace fingers and rub palm using the back of the hand for at least five times each.
10 Rub palm to palm with fingers interlaced
11 Rub the back of fingers to opposing palms with fingers interlocked.
12 Rub each thumb clasped in opposite hand using rotational movement.
Rotational rubbing, backwards and forwards with clasped fingers of right hand to left palm and
13
vice versa.
14 Rub each wrist with opposite hand.
15 Rinses thoroughly and inspects for remaining dirt or soap.
16 Dries hands from fingers to wrists with a hand or paper towel.
17 Turns off the faucet with use of paper towel.
OTHERS (30%)
18 Completed procedure within 40-60 seconds
19 Maintains body mechanics throughout the performance of the assessment.
20 Observes neatness and orderliness while performing the assessment.
21 Shows calmness and maintains composure while performing the procedure.
22 Exercises proper and fluent use of English language.
23 Shows mastery of the procedure.
TOTAL

RATING:
PERFORMANCE (70%)
OTHERS (30%) ___________________________
TOTAL

Comments:

__________________________ __________________________
Students' Signature CI's Signature

LCM RLES/08.03.21
 DAVAO DOCTORS COLLEGE
Gen. Malvar St., Davao City

NURSING PROGRAM

EVALUATIVE TOOL FOR NRG 203

OPEN GLOVING
NAME ________________________________ YEAR/SEC _____________ GRP.# ________
DATE ________________________________ FINAL RATING:

Directions: Each student is to be rated on performance in the return demonstration. Careful evaluation to be
taken to compare the jobs and tasks actually performed by the student nurse with those expected from the
full performance of that assignment. Keeping the guidelines in mind, please complete the Performance
Evaluation Tool. Then determine an overall rating, giving weight to various performance categories as
appropriate to the particular assignment. Please indicate remarks in the space provided if needed. Overall
rating must be considered with the following standard definition.

5 4 3 2 1
Perform thorough handwashing. Follows the steps in performing hand washing /
1
hand hygiene.
2 Prepare sterile gloves ensuring the correct size and inspect for tear and/or stains.
Remove outer wrapper of the glove package by carefully separating and peeling
3
apart sides.

4 Grasp the inner package and lay it on a clean, dry and flat-surfaced waist level area

Identify right and left glove, Each glove has cuff approximately 5 cm (2 inches)
4
wide. Glove dominant hand first.
With thumb and first two fingers of nondominant hand, grasp edge of cuff of glove
5
for dominant hand. Touch only inside surface of glove.

Carefully pull glove over dominant hand, leaving cuff and being sure that it does not
6
roll up wrist. Be sure that thumb and fingers are in proper spaces.

7 With gloved dominant hand, slip fingers underneath cuff of second glove.

Carefully pull second glove over nondominant hand. Do not allow fingers and thumb
8 of gloved dominant hand to touch any part of exposed dominant hand. Keep thumb
of dominant hand abducted back.
After second glove is on, interlock fingers of gloved hands and hold away from body
9
above waist level until beginning procedure.
10 Glove Disposal:
A. Grasp outside of one cuff with other gloved hand; avoid touching wrist. Pull
halfway
down palm of hand. Take thumb of half-ungloved hand and place under cuff of
other
glove.
B. Pull glove off, turning it inside out. Discard in receptacle.
C. Take fingers of bare hand and tuck inside remaining glove cuff. Peel glove off,
inside
out. Discard in receptacle.
11 Perform hand hygiene.
12 Observes neatness and orderliness while performing the assessment.
13 Shows calmness and maintains composure while performing the procedure.
14 Exercises proper and fluent use of English language.
15 Shows mastery of the procedure.
TOTAL

Comments:

__________________________ __________________________
Students' Signature CI's Signature

LCM RLES/08.03.21