REGISTRATION NUMBER ……………………………………………………….

EXAMINATION NUMBER ……………………………………………

THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH

NMT 06102: CARE OF A WOMAN WITH OBSTRETIC EMERGENCY CONDITIONS

SECTION B: ASSESSMENT OF LEARNER COMPETENCES

Instructions
 This checklist is used to assess learners’ competences on every Module during end of semester II practical examination
 The setting of practical examination is in health care facility (OPD, Maternity, Gynecological ward and Other Wards)
 This examination should not be conducted in skills laboratory
 Time allocated is 1 hour (50 minutes for procedure and 10 minutes for evaluation)
 The assessor is required to assign maximum score when sub-criteria is done/observed, if not done or done incorrectly assign zero (0) and write
comment in the comments ‘column
 Write the total score at the end of assessment
Formula:
Total sub criterion achieved in section (A + B) x 100%
Total sub-criterion in section (A+B)

 Write the final average score obtained by internal and external examiner at the top right corner after getting the average score from internal and external
examiner
 Write general comments below the checklist, if any, after the examination
 NOTE: Some of the steps/tasks may be performed simultaneously

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REGISTRATION NUMBER ………………………………………………………. EXAMINATION NUMBER ……………………………………………

CHECKLIST 3: COLLECTION AND MONITORING INPUT AND OUTPUT

(To be used to assess performance)
SN. Description of criterion Sub-criterion Maximum Obtained Comments
score score
1.1 Greets patient and introduces self 01
Physical and 1.2 Explains the procedure to the patient 01
1.0 1.3 Obtains patient consent 01
psychological preparation
1.4 Encourages client (s) to express any concern/physical needs. 01
Prior preparation of 2.1 Prepares urinal bottle, clean gloves 02
2.0
equipment and supplies
3.0 3.1 Performs hand washing/hygiene 02
4.1 Wears clean gloves 02
5.1 Places a woman in a comfortable position 02
6.1 Holds the urinal bag at eye level 02
7.1 Reads the amount (Volume) urine in accordance to label in urinal bag 02
8.1 Checks the colour of urine (Hematuria, pus) 02
Collection and monitoring 9.1 Checks for urine concentration 02
10.1 Places urinal bottle/receiver direct to the urinal bag 02
input and output 11.1 Opens the spigot to empty the urine the receiver 02
12.1 Closes the spigot of urine bag 02
13.1 Hangs the urinal bag bellow the patient bed 02
14.1 Covers urinal bottle/receiver and send it to the sluice room 02
15.1 Senses for smell of urine 02
16.1 Empties the urine to the sluice room pit 02
17.1 Rinses urinal bottle/receiver 02
18.1 Decontaminates urinal bottle/receiver according to policy 02
17.0 Caring equipment 18.2 Places the receiver/urinal bottle in upside- down to drain 02
18.3 Washes hands after the procedure 02

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REGISTRATION NUMBER ………………………………………………………. EXAMINATION NUMBER ……………………………………………

Documentation and 5.1 Records findings in the fluid balance chart 02

5.0 feedback 5.2 Reports findings to senior staff 01
Total score 45

General comment
…………………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………………
Name of internal examiner………………………………. Signature……………………….
Name of external examiner ………………………………. Signature………………………