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Republic of the Philippines

President Ramon Magsaysay State University
Iba, Zambales, Philippines
COLLEGE OF NURSING

PERFORMANCE EVALUATION CHECKLIST

BABY BATH

Name: ______________________________________________ Date: ___________________________

Year: ______________ Section: _____________ Group Number: ________________ Rating: ___________________

Direction: Please check the appropriate box below to describe verbalized or demonstrated competence level
using the following criteria:
5 Correctly and independently performs procedure and state rationale
4 Perform procedure and state the rationale with minimal guidance
3 Satisfactorily perform procedure with moderate guidance
2 Procedures incorrectly done without rationale
1 Not performed

5 4 3 2 1
Procedure

1. Explain procedure to the mother and encourage her participation

2. Gather all materials needed.

3. Provide privacy
4. Pour water into the tub and adjust temperature by checking with the elbow or
dorsal side of the palm

5. Undress the baby.

6. Place the head of the baby on your non dominant palm and support with
body with a forearm.
7. Close ears with the thump and middle finger of the non dominant hand

8. Wipe the eyes from inner canthus to outer canthus with cotton swabs
9. Dip hand in water and wipe face taking care that no water goes into the
mouth of infants.
10. Wet hair and apply soap or shampoo, gently wash the scalp . Rinse with water and
dry hair with towel. Drying immediately prevents the hypothermia
11. Place the baby into the tub with shoulders neck and head supported by the non
dominant hand and the trunk and legs in water .To start washing trunk
12. Wet the baby’s neck, chest, hands, abdomen, legs and perineum.
13. For cleaning back and buttocks transfer the baby to the other hand in such a
way that neck and chest are supported over the palm, by holding the baby
securely
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14. Apply soap concentrating on skinfolds and rinse with the water . Prevents skin
irritation.

15. Spread the towel over a flat surface. Place the baby on it and dry. For better
convenience
16. With the swab stick swab the inner and outer circle of cord. To prevent umbilical
infection
17. Dress the baby and cover blanket or towel. To prevent from the hypothermia
18. Document the following:
Type of bath
General conditions of the baby

actual points
Actual Points: _____90_______ Computation: x 60+40 Grade: ___________
Total score

Remarks:
_______________________________________________________________________________________________
_______________________________________________________________________________________________

Evaluated by: Conformer:

_______________________ __________________________
Clinical Instructor Signature of the Student

Noted by: Approved by:

Joel D. Federico, RN, MAN Celeste A. Orge, PhD., RN

Clinical Coordinator Dean, College of Nursing