Component Task New 1

CANDIDATE’S NUMBER…………………………………………………. SIGN. OF CAND………………………...……….
CENTRE……………………………………………………………………………………………… DATE…….………………….
MAKING A SIMPLE UNOCCUPIED BED

REQUIREMENTS:
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COMPONENT TASK RATING

1. Collect, arrange items on trolley and send to bedside 0 1 2 3 4
2. Arrange items in order of use on two chairs or cardiac table 0 1 2 3 4
3. Place bottom sheet evenly on bed 0 1 2 3 4
4. Tuck the sheets evenly under the mattress at the top and bottom using 0 1 2 3 4
enveloped corners
5. Pull and tuck sheet at the sides with no creases 0 1 2 3 4
6. Place draw mackintosh across the bed and cover with draw sheet 0 1 2 3 4
7. Slip the pillow case on the pillow with assistant 0 1 2 3 4
8. Place pillow on the bed with open ends away from the entrance 0 1 2 3 4
9. Place the top sheet on with the wrong side uppermost 0 1 2 3 4
10. Fold over at the bottom and tuck in loosely 0 1 2 3 4
11. Place the bed cover and counterpane loosely over the bed 0 1 2 3 4
12. Tuck in bedcover and counterpane at the bottom end using envelop corners 0 1 2 3 4
13. Fold top sheet over the bed cover (counterpane) at the top end 0 1 2 3 4
14. Tuck in sides under the mattress 0 1 2 3 4
15. Remove trolley and chairs 0 1 2 3 4
16. Wash and dry hands or use alcohol rub if applicable 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….
NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….
RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

CENTRE……………………………………………………………………………………………… DATE…….………………….
MAKING AN ADMISSION BED

REQUIREMENTS:
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3. Place bottom sheet evenly on bed 0 1 2 3 4
4. Tuck sheet evenly under the mattress at the top and bottom using enveloped 0 1 2 3 4
corners
6. Place long mackintosh on bed 0 1 2 3 4
7. Use one bath blanket or sheet over and tuck in all round or fold under itself 0 1 2 3 4
8. Place second bath blanket over the bed 0 1 2 3 4
9. Put in hot water bottle if necessary 0 1 2 3 4
10. Put on top bed clothes 0 1 2 3 4
11. Place counterpane loosely over the top bed clothes 0 1 2 3 4
12. Tuck in the bed clothes on the other side 0 1 2 3 4
13. Fold the bed clothes on the other side nearest to the door, leaving it open to 0 1 2 3 4
facilitate quick admittance
14. Move trolley and chairs 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
MAKING AN OPERATION BED

REQUIREMENTS:
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3. Place bottom sheet evenly on bed and tuck the sheet evenly under the mattress 0 1 2 3 4
at the top using envelop corners
4. Pull sheet tightly so that there are no creases and tuck the sheets under the 0 1 2 3 4
mattress at the bottom using enveloped corners
6. Place protective dressing towel at the top of bed 0 1 2 3 4
7. Leave pillow on chair by the bed 0 1 2 3 4
8. Spread blanket on the bed 0 1 2 3 4
9. Place top sheet on with the wrong side uppermost and turn back the bottom 0 1 2 3 4
end
10. Fold top bed cloth at the open side in three parts over the bed for easy 0 1 2 3 4
admission of patient
11. Place a post anaesthetic tray by the bed side containing vomitus bowl, dressing 0 1 2 3 4
towel, kidney dish containing swab, holding forceps, dissecting forceps, tongue
holding forceps and spatula
12. Arrange other bed accessories by the bed side – drip stand, bed rail, vital signs 0 1 2 3 4
tray, medication tray, suctioning machine, oxygen apparatus
13. Move trolley and chairs 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
MAKING A CARDIAC BED

REQUIREMENTS:
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3. Place bottom sheet evenly on bed and tuck the sheets under the mattress at the 0 1 2 3 4
top and bottom using enveloped corners
4. Pull sheet tightly so that there are no creases 0 1 2 3 4
5. Place draw mackintosh across the bed and cover with draw sheet and tuck in 0 1 2 3 4
6. Place covered air rings in between the draw mackintosh and draw sheet 0 1 2 3 4
7. Place/elevate back rest at the top of bed and arrange pillows in an arm chair-like 0 1 2 3 4
fashion
8. Place the top sheet on with the wrong side uppermost and fold over at the 0 1 2 3 4
bottom
9. Place foot rest in position 0 1 2 3 4
10. Place cardiac table with covered pillow in position 0 1 2 3 4
11. Place sputum mug and bell within reach of patient 0 1 2 3 4
12. Provide pen and paper if patient is literate 0 1 2 3 4
13. Clear chair/cardiac table, trolley, wash, dry hands or use alcohol rub if applicable 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CHANGING BOTTOM SHEET OF A PATIENT FROM TOP TO BOTTOM

REQUIREMENTS:
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1. Explain procedure to patient and provide privacy 0 1 2 3 4
2. Collect and arrange necessary items on trolley and send to bed side 0 1 2 3 4
3. Arrange items in order of use on chair/cardiac table at the bottom of the bed 0 1 2 3 4
4. Loosen sheets at the sides and foot end of the bed 0 1 2 3 4
5. Remove counterpane by folding it into three and place on chairs 0 1 2 3 4
6. Leave patient covered with the top sheet 0 1 2 3 4
7. Hold top sheet over patient’s shoulder with hand nearest to the head of the bed 0 1 2 3 4
8. Move patient to foot end of the bed with the help of an assistant and let patient 0 1 2 3 4
lean/rest on cardiac table with a pillow on top
9. Remove pillows on the head end of the bed and place on chair 0 1 2 3 4
10. Roll the soiled sheets down from the top end of the bed to the patient’s buttocks 0 1 2 3 4
11. Make top half foundation with clean sheets and arrange pillow at top half of bed 0 1 2 3 4
12. Help patient back to position, keeping him/her covered 0 1 2 3 4
13. Instruct assistant to lift patient’s legs while he/she removes the soiled bottom 0 1 2 3 4
sheet and place in the dirty linen container
14. Pull down the clean bottom sheet, mackintosh and draw sheets 0 1 2 3 4
15. Pull the bottom sheet tight and tuck in using envelope corners with the help of 0 1 2 3 4
assistant
16. Finish making bed using top sheet and make patient comfortable 0 1 2 3 4
17. Clear items and remove screen 0 1 2 3 4
18. Wash and dry hands and 0 1 2 3 4
19. Document findings 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CHANGING BOTTOM SHEET OF A PATIENT FROM SIDE TO SIDE

REQUIREMENTS:
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1. Explain procedure to patient and ensure privacy 0 1 2 3 4
2. Collect and arrange items on a trolley 0 1 2 3 4
3. arrange items in order of use on chairs or cardiac table 0 1 2 3 4
4. Remove any equipment attached to the side of the bed e.g. drip stand, side rails 0 1 2 3 4
etc.
5. Loosen sheet at the sides of the bed, leave patient with only one pillow and 0 1 2 3 4
cover him/her with top sheet
6. Assist the patient to turn to the side away from the clean portion of the linen 0 1 2 3 4
supported by assistant
7. Roll the dirty bottom sheet under patient 0 1 2 3 4
8. Cover the bed with a clean rolled bottom sheet halfway in the middle of the bed 0 1 2 3 4
9. Put on draw mackintosh and draw sheet across bed and tuck in greater part 0 1 2 3 4
nearest to door
10. Remove dirty bottom sheet and place it in a receptacle 0 1 2 3 4
11. Pull the bottom sheet tightly and tuck in 0 1 2 3 4
12. Cover patient with top sheet and counterpane and leave him/her comfortable 0 1 2 3 4
13. Clear items and remove screen 0 1 2 3 4
14. Complete bed making and make patient comfortable 0 1 2 3 4
15. Wash and dry hands 0 1 2 3 4
16. Document findings and report 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CHECKING OF VITAL SIGNS – TEMPERATURE, PULSE, RESPIRATION, BLOOD PRESSURE (USING THE
INDIVIDUAL ELECTRONIC THERMOMETER AND ELECTRONIC SPHYGMOMANOMETER)
REQUIREMENTS:
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1. Explain procedure to patient 0 1 2 3 4
2. Press knob to ensure thermometer and sphygmomanometer are functioning 0 1 2 3 4
3. Prepare and send tray to patient’s bed side 0 1 2 3 4
4. Make patient comfortable by lying/sitting up in bed, wash and dry hands or use 0 1 2 3 4
alcohol rub
5. Press knob again to show reading, expose axilla, dry with clean dry cotton swab 0 1 2 3 4
and discard
6. Clean the thermometer with dry cotton swab from bulb to stem 0 1 2 3 4
7. Insert thermometer into the axilla between two skin folds 0 1 2 3 4
8. Check and record pulse and respiration while thermometer is in axilla 0 1 2 3 4
9. Remove thermometer after beep, read, record and clean from stem to bulb and 0 1 2 3 4
insert thermometer back into its container
10. Chart readings of temperature, pulse and respiration 0 1 2 3 4
11. Stretch patient arm and place sphygmomanometer beside arm at the same level 0 1 2 3 4
12. Wind/wound/wrap cuff around arm above elbow 0 1 2 3 4
13. Inflate cuff by pressing the start knob and wait for reading to appear on screen 0 1 2 3 4
14. Remove cuff and reassemble apparatus 0 1 2 3 4
15. Thank and make patient comfortable 0 1 2 3 4
16. wash, dry hands and record readings 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CHECKING OF VITAL SIGNS – TEMPERATURE, PULSE, RESPIRATION, BLOOD PRESSURE (USING THE
INDIVIDUAL NON-DIGITAL THERMOMETER AND MERCURY OR ANEROID SPHYGMOMANOMETER)
REQUIREMENTS:
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1. Explain procedure to patient 0 1 2 3 4
2. Prepare and send tray to patient’s bed side 0 1 2 3 4
3. Make patient comfortable by lying/sitting up in bed 0 1 2 3 4
4. Dip the bulb of the thermometer into a gallipot containing water 0 1 2 3 4
5. Clean the thermometer from bulb to stem with dry cotton swab 0 1 2 3 4
6. Read thermometer at eye level and ensure mercury is at 35°C 0 1 2 3 4
7. Wipe patient’s axilla with a dry cotton wool swab and discard 0 1 2 3 4
8. Insert thermometer into the axilla between two skin folds 0 1 2 3 4
9. Leave thermometer in axilla for three full minutes 0 1 2 3 4
10. While the thermometer is in position, check pulse and respiration rate 0 1 2 3 4
11. Record pulse and respiratory rate 0 1 2 3 4
12. Remove thermometer, clean from stem to bulb at eye-level 0 1 2 3 4
13. Read thermometer at eye-level 0 1 2 3 4
14. Wash, dry hands or use alcohol rub and record temperature 0 1 2 3 4
15. Stretch patient arm and place sphygmomanometer at the shoulder level/ if 0 1 2 3 4
aneroid fix the manometer on the cuff
16. Wind/wound/wrap cuff around arm above elbow 0 1 2 3 4
17. Palpate radial artery and inflate cuff until pulse disappears 0 1 2 3 4
18. Check, wear and place stethoscope on the brachial artery 0 1 2 3 4
19. Release cuff pressure slowly and listen to sound with stethoscope 0 1 2 3 4
20. Remove cuff, fold and reassemble apparatus 0 1 2 3 4
21. Thank and make patient comfortable 0 1 2 3 4
22. wash, dry hands chart readings on vital signs chart 0 1 2 3 4
23. Record blood pressure readings on nurses note and vital signs chart 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
ADMISSION OF A PATIENT (AMBULANT)

REQUIREMENTS:
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1. Welcome patient and relatives to the nurses’ station and make them 0 1 2 3 4
comfortable
2. Introduce self (nurse) and any staff present 0 1 2 3 4
3. Collect necessary documents, admission notes and any other information from 0 1 2 3 4
accompanying nurse
4. Identify and confirm patient’s name, particulars and reassure him/her and 0 1 2 3 4
relatives
5. Send patient to bedside and introduce him/her to other patients near him/her 0 1 2 3 4
6. Check vital signs and record 0 1 2 3 4
7. Inform charge nurse of any urgent prescribed medication 0 1 2 3 4
8. Assist patient to change into his/her night gown/pajamas 0 1 2 3 4
9. Ask patient to declare valuables if any and inform charge nurse for safe keeping 0 1 2 3 4
10. Explain National Health Insurance system to patient and relative(s) 0 1 2 3 4
11. Orientate patient/relatives to the ward 0 1 2 3 4
12. Inform relatives about the visiting times as well as other ward activities and 0 1 2 3 4
allow relative(s) to see patient and bid goodbye
13. Enter patient’s name into admission, discharges book and daily ward state 0 1 2 3 4
14. Document on nurses’ note and plan care 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
ADMISSION OF A CHILD (AMBULANT)

REQUIREMENTS:
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1. Welcome child, parent(s)/caregiver(s) into nurses’ station, establish rapport 0 1 2 3 4
and make them comfortable
2. Ask child’s name and introduce self and other staff present to them an reassure 0 1 2 3 4
them of your support during admission
3. Get child’s record from accompanying nurse, confirm patient’s name and 0 1 2 3 4
diagnosis and apply identification band
4. Send child to the prepared cot/bed with side rails and introduce other children 0 1 2 3 4
near him/her
5. Administer urgent prescribed medication 0 1 2 3 4
6. Check vital signs, weight, height and record and collect specimen if ordered 0 1 2 3 4
7. Assist child to change into pajamas or hospital wear 0 1 2 3 4
8. Orientate child and parent(s)/caregiver(s) to the unit e.g. playroom, television 0 1 2 3 4
room, bathroom and toilet room as well as snack room if available
9. Educate child on how to call the nurse and emphasize the willingness to meet 0 1 2 3 4
his/her needs at all times
10. Explain the hospital ward policies e.g. visiting time, National Health Insurance 0 1 2 3 4
policies etc. to parent(s)/caregiver(s)
11. Ensure parent(s)/Legal guardians sign consent form for treatment where 0 1 2 3 4
necessary
12. Inform parent(s)/caregiver(s) to bring learning/playing material 0 1 2 3 4
13. Enter child’s name into admission and discharge book, daily ward state and 0 1 2 3 4
document on nurses’ notes
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
ADMISSION OF A SERIOUSLY ILL CHILD

REQUIREMENTS:
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1. Welcome child and parent(s)/caregiver(s), establish rapport and receive folder 0 1 2 3 4
from accompanying nurse
2. Check and confirm child’s name and diagnosis and immediate treatment 0 1 2 3 4
3. Put child into cot/bed and direct parent(s)/caregiver(s), to sit in the day room 0 1 2 3 4
while taking care of child
4. Administer immediate treatment or perform the necessary resuscitation 0 1 2 3 4
5. Check vital signs, weight and record 0 1 2 3 4
6. Take a brief history of child’s condition from parent(s)/caregiver(s) 0 1 2 3 4
7. Allow parent(s)/caregiver(s), to see where child is lying and orientate them to 0 1 2 3 4
the unit and its annexes
8. Explain ward and hospital policies, visiting time, National Health Insurance 0 1 2 3 4
Scheme, meal time etc. to parent(s)/caregiver(s)
9. Encourage parent(s)/caregiver(s) to bring child’s favourite toys etc. and find out 0 1 2 3 4
child’s likes and dislikes e.g. food
10. Guide parent(s)/caregiver(s) to sign consent form for treatment etc. if necessary 0 1 2 3 4
11. Enter child’s name into admission and discharge book, daily ward state 0 1 2 3 4
12. Document on nurses’ notes 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
DISCHARGING A PATIENT FROM THE HOSPITAL

REQUIREMENTS:
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1. Ensure that discharge papers are duly signed by the discharging doctor 0 1 2 3 4
2. Inform patient about discharge 0 1 2 3 4
3. Ensure that patients hospital bill is assessed and settled 0 1 2 3 4
4. Educate patient and relatives on the need for continuing treatment and follow 0 1 2 3 4
up care
5. Record all receipt numbers in admission and discharge book and hand over 0 1 2 3 4
receipt to patient or relatives
6. Collect medication for patient from hospital’s pharmacy where applicable 0 1 2 3 4
7. Explain how medication should be taken and stored at home 0 1 2 3 4
8. Help patient to pack his or her belongings 0 1 2 3 4
9. Hand over any valuables in nurses’ custody to the patient or relative(s) and 0 1 2 3 4
record, witnessed and signed
10. Remind patient and relative(s) of review date and stress on its importance 0 1 2 3 4
11. Thank and bid them good-bye 0 1 2 3 4
12. Document in the admission and discharge book, daily ward state and nurses’ 0 1 2 3 4
notes
13. Ensure linen are removed, bed and lockers decontaminated 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
ORIENTATION OF PATIENT TO THE WARD ENVIRONMENT (AMBULANT)

REQUIREMENTS:
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1. Establish rapport with patient by introducing herself. 0 1 2 3 4
2. Mentions the name of the ward to him. 0 1 2 3 4
3. Introduces patient to ward staff around and other patients. 0 1 2 3 4
4. Shows patient the nurses office, shows patient his bed. 0 1 2 3 4
5. Shows patient the bathroom and the toilet. 0 1 2 3 4
6. Shows patient dining hall and dayroom. 0 1 2 3 4
7. Shows patient the patients’ cupboard and bed locker. 0 1 2 3 4
8. Informs patient of ward activities. 0 1 2 3 4
9. Tells patient whom to contact for any information. 0 1 2 3 4
10. Encourages patient to ask questions. 0 1 2 3 4
11. Thank patient and put him to bed. 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
EDUCATING A PATIENT ON CONDITION

REQUIREMENTS:
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1. Explain the need for education to patient 0 1 2 3 4
2. Make patient comfortable either by sitting or lying down 0 1 2 3 4
3. Sit comfortably on a chair by patient’s side 0 1 2 3 4
4. Ensure enabling and relaxed environment to maintain privacy and individuality 0 1 2 3 4
of patient
5. Find patient’s level of awareness of condition 0 1 2 3 4
6. Build on what the patient already knows with scientific data of condition in 0 1 2 3 4
language that patient understands
7. Explain to patient the rationale for treatment and possible outcome 0 1 2 3 4
8. Ensure patient understands the teaching and co-operates with the health team 0 1 2 3 4
9. Allow the patient to ask questions for clarification 0 1 2 3 4
10. Provide patient with clear simple pamphlets if available 0 1 2 3 4
11. Thank patient and document education 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
EDUCATING A PATIENT ON MEDICATION PRIOR TO DISCHARGE

REQUIREMENTS:
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1. Identify patient’s treatment chart and medication 0 1 2 3 4
2. Establish rapport with patient 0 1 2 3 4
3. Use language patient understands 0 1 2 3 4
4. Involve patient’s and/or significant others 0 1 2 3 4
5. Speak audibly to patient 0 1 2 3 4
6. Explain procedure to patient’s family 0 1 2 3 4
7. Assess patient’s previous knowledge on medication 0 1 2 3 4
8. Show type of medication to patient and/or significant others 0 1 2 3 4
9. Inform patient/or significant others about route of administration 0 1 2 3 4
10. Instruct patient and/or significant others on dosage of medication to be taken 0 1 2 3 4
at a time
11. Explain action of medication to patient and/or significant others 0 1 2 3 4
12. Describe the side effect of the medication to patient and/or significant others 0 1 2 3 4
13. Instruct patient and/or significant others to hospital when serious side effects 0 1 2 3 4
occur
14. Demonstrate to patient and/or significant others how to store drug at home 0 1 2 3 4
safely
15. Allow patient and/or significant others to repeat instruction and ask question(s) 0 1 2 3 4
16. Respond to questions appropriately 0 1 2 3 4
17. Thank patient and/or significant others for co-operating and document
procedure in the nurses’ notes
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
HANDING OVER THE WARD

REQUIREMENTS:
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1. Welcome the in-coming staff 0 1 2 3 4
2. Give ward reports on patients to in-coming nurse to read 0 1 2 3 4
3. Enquire from in-coming nurse if he/she needs further explanation on 0 1 2 3 4
occurrences on the ward
4. Hand over sensitive information about patients at the nurses’ office 0 1 2 3 4
5. Interact with patients while handing over 0 1 2 3 4
6. Check and confirm information about patient’s charts and notes 0 1 2 3 4
7. Check with in-coming staff if gadgets on patient’s are functioning e.g. cardiac 0 1 2 3 4
monitor, intravenous line, oxygen flow meter etc.
8. Check and hand over controlled medications and other relevant consumables 0 1 2 3 4
available
9. Hand over ward annexes for in-coming nurse to ensure they are clean 0 1 2 3 4
10. Report on any defects on equipment and request for urgent repairs 0 1 2 3 4
11. Report on departmental instructions and other important information 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
TAKING OVER THE WARD

REQUIREMENTS:
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1. Greet staff on duty 0 1 2 3 4
2. Ask for oral information on major happenings on the ward from the outgoing 0 1 2 3 4
nurse
3. Read ward written reports 0 1 2 3 4
4. Enquire sensitive information about patients at the nurses’ office 0 1 2 3 4
5. Take over ward from bed to bed verifying the state of all patients; especially the 0 1 2 3 4
seriously ill
6. Establish rapport with patients during taking over and ask about general health 0 1 2 3 4
7. Conduct inspection of ward with outgoing staff 0 1 2 3 4
8. Ensure resources needed for work are available and adequate and take over 0 1 2 3 4
controlled medication
9. Counter-sign written ward report 0 1 2 3 4
10. Note important issues and document 0 1 2 3 4
11. Congratulate out-going staff 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
PREPARATION AND CARE OF PATIENT DURING AND AFTER LUMBER PUNCTURE
REQUIREMENTS:
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1. Explain the procedure to the patient and reassure him/her to gain co-operation 0 1 2 3 4
2. Ensure consent form has been signed 0 1 2 3 4
3. Provide privacy and instruct patient to void before the procedure 0 1 2 3 4
5. Open the equipment tray, take care not to contaminate 0 1 2 3 4
6. Provide adequate lightening at the puncture site 0 1 2 3 4
7. Assist patient into a required position, i.e. lying or siting and support him/her 0 1 2 3 4
8. Continue to support, observe and reassure patient throughout the procedure 0 1 2 3 4
9. Wear sterile gloves and apply sterile dressing when needle is withdrawn and 0 1 2 3 4
secure firmly with an adhesive tape
10. Allow patient to lie flat on the back and make him/her comfortable 0 1 2 3 4
11. Observe patient for the next 24 hours for the following;
a) Leakage from puncture site 0 1 2 3 4
b) Headache 0 1 2 3 4
c) Backache 0 1 2 3 4
12. Check and record vital signs 0 1 2 3 4
13. Thank patient, wash and dry hands 0 1 2 3 4
14. Document procedure 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
PREPARING PATIENT AND A TROLLEY FOR LUMBAR PUNCTURE

REQUIREMENTS:
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1. Explain procedure to patient and ensure his/her co-operation and provide 0 1 2 3 4
privacy
2. Wash, dry hands and prepare trolley with the following items: 0 1 2 3 4
3. Top shelve 0 1 2 3 4
i. Sterile fenestrated drape, sterile gallipot with sterile cotton wool swab
ii. Sterile gallipot containing antiseptic cleaning agent
iii. Sterile dressing pack
4. Bottom shelve 0 1 2 3 4
i. Sterile gloves pack for the doctor and nurse
ii. Pack of examination glove
iii. Face mask
5. i. Receiver for soiled swabs 0 1 2 3 4
ii. Receiver for used instrument
6. i. 2ml syringe for local anaesthetic agent 0 1 2 3 4
ii. 18G or 20G 34 spinal needle with stylet
iii. Three way stop cork
iv. Manometer
v. Adhesive strapping
7. i. Three (3) labelled specimen collection tubes with stopper 0 1 2 3 4
ii. Laboratory request forms
iii. Light source (touch light)
iv. Counter scissors
v. Vital signs tray
8. i. Bring trolley to bed side and provide privacy 0 1 2 3 4
ii. Wash, dry hands and open the top shelve
9. Assist patient to lie on his/her side at the edge of the bed and assume the knee 0 1 2 3 4
chest or fetal position
10. Place one hand behind his/her neck and other behind his/her knees and assist 0 1 2 3 4
Patient to maintain the assumed position
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
DRESSING OF WOUND (SIMPLE OR UNCOMPLICATED)

REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Establish rapport and explain procedure to patient 0 1 2 3 4
2. Put on mask, prepare and take trolley to the patient’s bedside and provide 0 1 2 3 4
privacy
3. Put patient into desired position, protect bed clothes and expose the wound 0 1 2 3 4
4. Pour lotion into gallipot and remove plaster or bandage 0 1 2 3 4
5. Remove soiled dressing with dissecting forceps or gloved hand, discard, 0 1 2 3 4
6. Wash and dry hands and wear sterile gloves or use sterile forceps 0 1 2 3 4
7. Clean wound with swabs soaked in normal saline using sterile forceps/gloves 0 1 2 3 4
starting from the wound outward using one swab at a time
8. Clean wound with series of swabs until wound is clean 0 1 2 3 4
9. Apply sufficient sterile dressing and secure into position 0 1 2 3 4
10. Make patient comfortable in bed, inform patient about state of the wound and 0 1 2 3 4
thank him/her
11. Remove gloves, wash hands, dry hands, discard trolley, decontaminate 0 1 2 3 4
instruments, remove screen
12. Wash, dry hands, document and report state of wound 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
DRESSING OF WOUND
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Explain procedure to patient and ensure privacy 0 1 2 3 4
2. Put on mask, prepare and take trolley to the patient’s bedside 0 1 2 3 4
3. Position patient comfortably and protect bed clothes 0 1 2 3 4
4. Expose area of wound and remove plaster or bandage 0 1 2 3 4
5. Wash, dry hands, assemble instruments and pour lotions into gallipot 0 1 2 3 4
6. Remove soiled dressing with dissecting forceps or gloved hand, discard, wash 0 1 2 3 4
and dry hands
7. Dab or clean wound with sterile forceps/gloves using prescribed lotion or where 0 1 2 3 4
necessary gently irrigate wound with syringe and saline from within outward
and clean the surrounding skin
8. Clean or dab wound with series of swabs until wound is clean 0 1 2 3 4
9. Apply sterile dressing using prescribed dressing lotion, add enough sterile 0 1 2 3 4
dressing and secure into position or leave exposed where necessary
thank him/her
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
DRESSING OF WOUND (WITH ASSISTANT)

REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Establish rapport and explain procedure to patient 0 1 2 3 4
2. Put on mask, prepare and take trolley to the patient’s bedside and ensure 0 1 2 3 4
privacy
3. Ask assistant to: 0 1 2 3 4
i. Put patient into desired position
ii. Protect bed cloth and expose wound
4. Ask assistant to 0 1 2 3 4
i. Pour out lotion into gallipot
ii. Remove plaster or bandage
5. Remove soiled dressing using disserting forceps or disposable gloves and 0 1 2 3 4
discard
6. Wash and dry hands and wear sterile gloves or use sterile forceps 0 1 2 3 4
7. Clean wound with sterile swabs soaked in normal saline using sterile forceps or 0 1 2 3 4
sterile gloves starting from the wound outward using one swab at a time
8. Clean wound with series of swabs until wound is clean 0 1 2 3 4
9. Apply sufficient sterile dressing and secure into position 0 1 2 3 4
thank him/her
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CARE OF TRACHEOSTOMY TUBE

REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Explain procedure to patient, engage his co-operation and provide privacy 0 1 2 3 4
2. Prepare trolley and send to the bedside 0 1 2 3 4
3. Wear disposable glove and suction the tracheostomy tube 0 1 2 3 4
4. Remove the inner tube by turning the lock 90° counter clockwise with the 0 1 2 3 4
dominant hand and the non-dominant hand to remove the inner cannula by
gently pulling it out
5. Soak the inner canula in hydrogen peroxide for five minutes and suction the 0 1 2 3 4
outer cannula
6. Remove gloves, wash hands and put on sterile gloves 0 1 2 3 4
7. Remove the inner tube from hydrogen solution into the sterile bowl with saline 0 1 2 3 4
solution and brush the lumen and entire inner cannula thoroughly
8. Rinse the inner cannula in a clean saline solution and dry the inner side of the 0 1 2 3 4
cannula with gauze squares twisted together
9. Re-insert inner cannula into outer cannula and turn 90° clockwise to lock 0 1 2 3 4
10. Clean the stoma using square gauze on forceps or with sterile cotton buds with 0 1 2 3 4
saline solution. If there are debris, clean with hydrogen peroxide before saline
solution
11. Apply a sterile dressing and change the tie tapes, check tightness of 0 1 2 3 4
tracheostomy tie.
12. Thank patient, discard and decontaminate equipment 0 1 2 3 4
13. Wash and dry hands
14. Document procedure and findings
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CARE FOR A PATIENT WITH UNDER WATER-SEALED DRAINAGE

REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Explain procedure and reassure patient and put him/her in the fowlers or semi 0 1 2 3 4
fowlers position
2. Check vital signs and record (baseline data) 0 1 2 3 4
3. Wash hands and don gloves 0 1 2 3 4
4. Place the bottle below the chest level in a receptacle 0 1 2 3 4
5. Check the rate and depth of respiration, chest movement and auscultate lungs 0 1 2 3 4
his/her periodically
6. Observe dressing site for bleeding and dislodgement of tube and inspect air vent 0 1 2 3 4
in the system periodically
7. Check fluid level fluctuation and bubbling in the drainage system 0 1 2 3 4
8. Check tube for kinking or perforations 0 1 2 3 4
9. Encourage patient to cough frequently and breathe deeply every two hours if 0 1 2 3 4
indicated
10. Assess patency of drainage system as evidenced by oscillations in the tubing and 0 1 2 3 4
bubbling in the water
11. Tell patient to report any breathing difficulty immediately 0 1 2 3 4
12. Check and change chest tube dressing when necessary and palpate the area 0 1 2 3 4
surrounding the dressing for crepitus
13. Observe the volume, colour, consistency and odour of the drainage 0 1 2 3 4
14. Thank the patient for co-operation, wash and dry hands 0 1 2 3 4
15. Administer pain medication as needed for patient’s comfort 0 1 2 3 4
16. Encourage chest expansion exercise (blowing of balloon) 0 1 2 3 4
17. Wash and dry hands again and document procedure noting No. 13 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CHANGING OF COLOSTOMY BAG AND CARE OF STOMA
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Explain the procedure to the patient and provide privacy 0 1 2 3 4
2. Prepare and send trolley to bedside 0 1 2 3 4
3. Turn down top sheet to expose stoma 0 1 2 3 4
4. Protect site with mackintosh and dressing towel 0 1 2 3 4
5. Put on disposable gloves and remove soiled bag gently and place in large 0 1 2 3 4
receiver
6. Remove disposable gloves, wash and dry hands 0 1 2 3 4
7. Put on sterile gloves, washes area around stoma with soap/mild detergent and 0 1 2 3 4
warm water
8. Dress area gently with sterile cotton wool balls and apply barrier cream/zinc 0 1 2 3 4
oxide cream
9. Estimate stoma and fit correct size of stoma bag 0 1 2 3 4
10. Remove gloves, wash and dry hands 0 1 2 3 4
11. Make patient comfortable and thank him/her 0 1 2 3 4
12. Discard soiled articles 0 1 2 3 4
13. Clean, sterilize and store used items 0 1 2 3 4
14. Document procedure and report any abnormalities 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
PRE-OPERATIVE PREPARATION OF PATIENT FOR SURGERY
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Explain procedure to patient and reassure him/her 0 1 2 3 4
2. Prepare a trolley with the following items: gauze, antiseptic lotion, plaster, bowl 0 1 2 3 4
of water, soap and sponge, operating towel, theatre gown, vital signs tray,
mackintosh and dressing towel
3. Send trolley to bedside and provide privacy 0 1 2 3 4
4. Place the patient into desired position 0 1 2 3 4
5. Expose the area to be prepared and protect the bed clothes 0 1 2 3 4
6. Wear gloves, wash the area with soap and water 0 1 2 3 4
7. Dry and clean area with antiseptic lotion 0 1 2 3 4
8. Cover area with operating towel and secure it in position with adhesive 0 1 2 3 4
strapping
9. Gown patient with a clean theatre gown 0 1 2 3 4
10. Ask patient to empty bladder and remove dentures if any 0 1 2 3 4
11. Check vital signs and record 0 1 2 3 4
12. Give prescribed pre-medication when patient is ready for the theatre if 0 1 2 3 4
necessary
13. Thank patient, discard trolley, wash and dry hands 0 1 2 3 4
14. Document procedure 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
IMMEDIATE POST-OPERATIVE CARE OF PATIENT FROM THE THEATER
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

Operation bed, Post anaesthetic tray, Oxygen cylinder, Suction machine, Vital
signs tray, Screen, Infusion stand
2. Receive patient gently into bed and reassure him/her if conscious 0 1 2 3 4
3. Place patient flat on bed with the head turned to one side or in the appropriate 0 1 2 3 4
position according to the operation performed
4. Provide bed rails for safety if necessary 0 1 2 3 4
5. Read through the patient’s case notes for post-operative instructions 0 1 2 3 4
6. Observe for level of consciousness by the use of stimulus e.g. pointed object or 0 1 2 3 4
by calling patient by name
7. Monitor vital signs for 15minutes for first 1hour, 30minutes for the next 1hour, 0 1 2 3 4
1hour for the next 4hours and 4hourly intervals as condition stabilizes
8. Observe for bleeding from operated site and report for possible reinforcement 0 1 2 3 4
9. Ensure cannula is in situ, check the flow rate of the intravenous fluid and 0 1 2 3 4
regulate as ordered
10. Check and ensure that all drainage tubes e.g. naso-gastric tube and catheter are 0 1 2 3 4
in situ and are draining well
11. Record intake and output accurately 0 1 2 3 4
12. Assess for pain and give prescribed analgesic and record 0 1 2 3 4
13. Check and administer all prescribed medications per the appropriate route 0 1 2 3 4
14. Maintain personal and oral hygiene 0 1 2 3 4
15. Observe any abnormality in the patient’s condition and document findings and 0 1 2 3 4
nursing interventions
16. Put patient in a comfortable position or as ordered by the surgeon when he/she 0 1 2 3 4
is fully conscious
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
FEEDING A PATIENT PER NASO-GASTRIC TUBE
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

2. Send prepared feed in a tray to patient’s bedside 0 1 2 3 4
3. Assist patient into a fowler’s position in bed or a sitting up position in a chair, or 0 1 2 3 4
a slightly elevated right-side lying position
4. Make patient comfortable and protect his/her clothes 0 1 2 3 4
5. Check for proper placement of tube in the stomach by aspirating abdominal 0 1 2 3 4
contents for a typical gastric fluid appearance (grassy-green, colourless with
mucous shreds) or inject 5 – 20cc of air through the tube and auscultate
epigastric region with a stethoscope and listen for the whooshing sound
simultaneously indicating proper positioning
7. Check temperature or feed by dropping a little amount on the back of the hand 0 1 2 3 4
8. Pinch tube and remove spigot of naso-gastric tube, push 10 – 15ml of water 0 1 2 3 4
through the tube just before feed is introduced
9. Connect syringe with feed to tube, release the pinch and allow feed to run by 0 1 2 3 4
gravity
10. Ensure tube is never allowed to empty completely to prevent air from entering 0 1 2 3 4
patient’s stomach
11. Continue feeding and observe patient for signs of discomfort till feeding is 0 1 2 3 4
completed
12. Flush the tube with 10 -15ml of water at the end of feeding 0 1 2 3 4
13. Pinch tube and remove syringe and replace spigot 0 1 2 3 4
14. Assist patient to remain in the sitting position for at least 30 minutes after feed 0 1 2 3 4
15. Remove protective clothing, and make patient comfortable, discard tray, wash 0 1 2 3 4
and dry hands
16. Document procedure on intake and output chart and nurses’ notes 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
FEEDING A HELPLESS PATIENT
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Explain procedure to patient, consider likes and dislikes and provide privacy 0 1 2 3 4
2. Inform patient about meal to be served to stimulate his/her appetite 0 1 2 3 4
3. Ensure clean atmosphere, clear all bed pans, urinals and vomitus bowls and 0 1 2 3 4
ensure brightness in the room
4. Put patient in a comfortable position if condition would allow it 0 1 2 3 4
5. Put patient in a sitting up position and arrange pillows on the bed rest to support 0 1 2 3 4
him/her or in the lying position, elevate the head of the bed
6. Place prepared tray on the bed table or patient’s locker 0 1 2 3 4
7. Give patient a mouthwash 0 1 2 3 4
8. Wash patient’s hands with soap and water and dry with clean towel 0 1 2 3 4
9. Wash and dry hands before serving meals (the nurse) 0 1 2 3 4
10. Place napkin/serviette across chest to protect patient’s clothing 0 1 2 3 4
11. Sit on a chair at the bedside of the patient if convenient to make him/her feel 0 1 2 3 4
relaxed
12. Cut feed into bite sizes and feed patient with levelled spoonful a little at a time 0 1 2 3 4
13. Allow patient enough time to chew and swallow 0 1 2 3 4
14. Observe the rate at which the patient eats 0 1 2 3 4
15. Co-ordinate the opening of the mouth and introduction of food into the mouth 0 1 2 3 4
16. Place the spoon or fork accurately into the mouth i.e. not too far back to 0 1 2 3 4
produce gargling
17. Serve sips of water in between feeding with a spoon or flexible straw 0 1 2 3 4
18. Clean or wipe patient’s mouth and chin during and after the meal when 0 1 2 3 4
necessary
19. Serve water, rinse mouth, remove used napkin/serviette and clear tray 0 1 2 3 4
20. Congratulate patient for efforts made in eating, wash and dry his/her hand with 0 1 2 3 4
a towel
21. Encourage patient to comment on the food served 0 1 2 3 4
22. Make patient comfortable 0 1 2 3 4
23. Wash and dry hands (nurse) 0 1 2 3 4
24. Document procedure in the nurses’ notes and/or fluid intake and output chart 0 1 2 3 4
if applicable
SCORE OBTAINED………………………………………………………………………………………………………………………………….
CENTRE……………………………………………………………………………………………… DATE…….………………….
MOUTH CARE FOR A SERIOUSLY ILL PATIENT
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

2. Prepare a tray and take it to the patient’s bedside 0 1 2 3 4
3. Put patient in a suitable position 0 1 2 3 4
4. Protect patient’s gown and bed linen with mackintosh and towel 0 1 2 3 4
5. Pour lotion into gallipots, wash and dry hands 0 1 2 3 4
6. Clean lips and outer part of teeth. Opens mouth with padded spatula. Inspect 0 1 2 3 4
mouth for any abnormalities and remove dentures if any
7. Take swab with forceps, dip into cleansing lotion and squeeze out excess 0 1 2 3 4
8. Clean mouth thoroughly but gently i.e. from inside the cheeks, both sides of 0 1 2 3 4
gums, tongue and palate changing swabs frequently
9. Control movement of the tongue with spatula 0 1 2 3 4
10. Use tooth pick to clean in between teeth 0 1 2 3 4
11. Clean mouth with water or any mouth wash 0 1 2 3 4
12. Clean lips and apply Vaseline 0 1 2 3 4
13. Make patient comfortable in bed and remove screen 0 1 2 3 4
14. Discard tray, decontaminate, wash and sterilize instruments 0 1 2 3 4
15. Wash, dry hands and document procedure and findings 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
RECORDING OF INTAKE AND OUTPUT
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Explain the importance of keeping the fluid balance chart to patient to gain 0 1 2 3 4
his/her co-operation
2. Explain the role patient has to play to him or her 0 1 2 3 4
3. Get requirements e.g. measuring jugs for intake and output, fluid chart and pen 0 1 2 3 4
4. Wash and dry hands and don gloves if applicable 0 1 2 3 4
5. Record in milliliters the amount of infusion/transfusion and other fluid intake at 0 1 2 3 4
fluid column
6. Record in milliliters any output such as urine, watery stool, vomitus at output 0 1 2 3 4
column
7. Total intake and output for 24 hours depending on hospital’s policy 0 1 2 3 4
8. Find fluid balance by subtracting output from intake 0 1 2 3 4
9. Document findings (characteristics of output) 0 1 2 3 4
10. Inform the nurse incharge/doctor immediately if amount of output is greater 0 1 2 3 4
than the amount taken in or when there is abnormally low output
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
BED BATHING
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

2. Prepare and take trolley to bedside 0 1 2 3 4
3. Offer bedpan or urinal if required 0 1 2 3 4
4. Loosen and remove top bed clothes and arrange on a chair/bed table 0 1 2 3 4
5. Remove patient’s clothes and cover him/her with a bed linen 0 1 2 3 4
6. Protect bed and pillow with long mackintosh and a bath towel/blanket 0 1 2 3 4
7. Maintain individuality of patient by asking him/her if he/she would like soap on 0 1 2 3 4
the face, temperature of water or if he/she would like to clean the genitalia
himself/herself
8. Wash, rinse and dry patient face beginning from the inner to the outer canthus 0 1 2 3 4
of each eye
9. Wash, rinse and dry the rest of the face, ears and neck 0 1 2 3 4
10. Wash, rinse and dry patient’s arm farther away from the nurse then wash, rinse 0 1 2 3 4
and dry patient’s arm near to nurse
11. Wash, rinse and dry the chest and abdomen paying attention to the skin folds 0 1 2 3 4
12. Wash, rinse and dry the legs in the same way as the arms 0 1 2 3 4
13. Turn patient on his/her sides and wash, rinse and dry the back 0 1 2 3 4
14. Examine and treat pressure areas 0 1 2 3 4
15. Change bottom linen and roll patient on his/her back 0 1 2 3 4
16. Clean patient’s genitalia (perform vulva toileting if a female) 0 1 2 3 4
17. Groom and dress patient in clean clothes 0 1 2 3 4
19. Discard trolley, wash and dry hands properly 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CARE OF PATIENT IN SKELETAL TRACTION
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

2. Set up trolley with sterile dressing set, sterile cotton balls, sterile gauze packs, 0 1 2 3 4
normal saline and povidone iodine
3. Wash hands and observe infection prevention measures and inspect the 0 1 2 3 4
traction apparatus
4. Ensure patient is in the appropriate position, and check that the head, knee and 0 1 2 3 4
foot of bed are properly elevated and trapeze well padded
5. Turn patient as a unit to prevent neck from twisting 0 1 2 3 4
6. In case of dislodgement of skull or Steinmann’s pin, support the head, remove 0 1 2 3 4
the weight, place sandbags or water bags on either side of the head or leg to
maintain proper alignment
7. Assess neurovascular status of the affected extremity 0 1 2 3 4
8. Inspect carefully the pin site daily to detect infections early and provide pin site 0 1 2 3 4
care using aseptic technique
9. Remove crust from site and apply prescribed dressing agent and loosely apply 0 1 2 3 4
gauze dressing around the pin site, obtain sample if purulent for laboratory
investigation
10. Teach patient deep breathing and coughing exercise of the unaffected limb 0 1 2 3 4
11. Thank patient for his co-operation 0 1 2 3 4
12. Wash, dry hands and document procedure noting abnormalities 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
INSERTION OF AN INDWELLING CATHETER (FEMALE)
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

2. Prepare and take trolley to bedside 0 1 2 3 4
3. Offer bedpan or urinal if required 0 1 2 3 4
4. Loosen and remove top bed clothes and arrange on a chair/bed table 0 1 2 3 4
5. Remove patient’s clothes and cover him/her with a bed linen 0 1 2 3 4
6. Protect bed and pillow with long mackintosh and a bath towel/blanket 0 1 2 3 4
7. Maintain individuality of patient by asking him/her if he/she would like soap on 0 1 2 3 4
the face, temperature of water or if he/she would like to clean the genitalia
himself/herself
8. Wash, rinse and dry patient face beginning from the inner to the outer canthus 0 1 2 3 4
of each eye
9. Wash, rinse and dry the rest of the face, ears and neck 0 1 2 3 4
10. Wash, rinse and dry patient’s arm farther away from the nurse then wash, rinse 0 1 2 3 4
and dry patient’s arm near to nurse
11. Wash, rinse and dry the chest and abdomen paying attention to the skin folds 0 1 2 3 4
12. Wash, rinse and dry the legs in the same way as the arms 0 1 2 3 4
13. Turn patient on his/her sides and wash, rinse and dry the back 0 1 2 3 4
14. Examine and treat pressure areas 0 1 2 3 4
15. Change bottom linen and roll patient on his/her back 0 1 2 3 4
16. Clean patient’s genitalia (perform vulva toileting if a female) 0 1 2 3 4
17. Groom and dress patient in clean clothes 0 1 2 3 4
19. Discard trolley, wash and dry hands properly 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
REMOVAL OF AN INDWELLING CATHETER
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

2. Prepare and send tray to bedside 0 1 2 3 4
3. Position patient as for catheterization 0 1 2 3 4
4. Place mackintosh and dressing towel beneath the patient and around the 0 1 2 3 4
genital area
6. Don gloves and place a towel between legs of the female patient/on the thigh 0 1 2 3 4
of male patient
7. Insert the syringe into the injection port of the catheter and gently withdraw 0 1 2 3 4
water from the balloon
8. Withdraw the catheter gently and place in the waste receptacle 0 1 2 3 4
9. Dry he genital area with a towel 0 1 2 3 4
10. Measure urine in the drainage bag and remove gloves 0 1 2 3 4
11. Thank patient and discard used items 0 1 2 3 4
12. Wash, dry hands and document findings 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CATHETER CARE FOR A FEMALE PATIENT
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

2. Wash, dry hands and assemble the following: 0 1 2 3 4
(a) Sterile indwelling catheter (correct size)
(b) Syringe filled with 5 – 10ml of normal saline/sterile water
(c) Jug of warm water, soap and towel
(d) Sterile gloves
(e) Sterile drape, sterile fenestrated drape
(f) Sterile cotton wool
(g) Antiseptic cleansing agent
(h) Urine bag
(i) Lubricant e.g. xylocaine jelly
(j) Intake and output chart
(k) Urine specimen container and laboratory request form where applicable
(l) Sterile forceps
(m) Receiver
(n) Bedpan
3. Protect bed with mackintosh, towel and ensure adequate lighting 0 1 2 3 4
4. Wash, dry hands don gloves 0 1 2 3 4
5. Instruct assistant to place patient in supine position with knees flexed and legs 0 1 2 3 4
separated
6. Place bedpan under patient and wash the perineum thoroughly with soap and 0 1 2 3 4
water
7. Clean patient, remove bedpan and drape with sterile towel 0 1 2 3 4
8. Remove the gloves, wear sterile gloves and clean the vulva with an antiseptic 0 1 2 3 4
cleaning agent.
9. Lubricate catheter with xylocaine jelly 0 1 2 3 4
10. Use the non-dominant hand to part the labia and establish a firm but gentle 0 1 2 3 4
position
11. Pick a cotton wool ball soaked in antiseptic with forceps in the dominant hand 0 1 2 3 4
and swab one side of the labia majora from top to bottom, use a new ball for
opposite side
12. Repeat procedure for labia minora, use another cotton wool ball to clean over 0 1 2 3 4
the meatus
13. Insert catheter into the urethral gently about 5cm 0 1 2 3 4
14. Inflate the balloon of the catheter with sterile water according to 0 1 2 3 4
manufacturer’s direction
15. Collect a urine specimen if needed and allows 20 – 30ml to flow into bottle 0 1 2 3 4
without bottle touching the catheter
16. Connect catheter to urine bag, hang to bed and secure in position 0 1 2 3 4
17. Observe colour, note amount of urine 0 1 2 3 4
18. Remove drape and make patient comfortable in bed 0 1 2 3 4
19. Thank patient and discard trolley 0 1 2 3 4
20. Wash, dry hands and document any abnormalities 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
CATHETER CARE FOR A MALE PATIENT
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Establish rapport and explain the procedure to patient and 0 1 2 3 4
2. Assemble necessary items 0 1 2 3 4
3. Ensure privacy 0 1 2 3 4
4. Wash, dry hands and put patient in the supine position 0 1 2 3 4
5. Place mackintosh and towel under patient 0 1 2 3 4
6. Cover patient up so that only the vulva is exposed. 0 1 2 3 4
7. Remove anchor device to free the catheter tubing, remove gloves, wash and dry 0 1 2 3 4
hands and wear sterile gloves
8. Retract foreskin if present to expose urethral meatus, clean around catheter 0 1 2 3 4
first, and then wipe in a circular motion around meatus and glans
9. Inspect urethral meatus for discharge 0 1 2 3 4
10. Use cotton wool swab soaked in antiseptic lotion, wipe in a circular motion 0 1 2 3 4
along the length of catheter and anchor back into position
11. Apply antibiotic ointment at urethral meatus and along 2.5cm of catheter if 0 1 2 3 4
ordered by Physician/Surgeon
12. Remove gloves, wash, dry hands, place patient in a safe and comfortable 0 1 2 3 4
position and remove screen
13. Discard tray/trolley, wash, dry hands, record and report findings 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
ADMINISTRATION OF TABLET
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Identify patient by mentioning the name and check treatment sheet against 0 1 2 3 4
doctor’s order
2. Explain procedure to patient and send tray to bedside 0 1 2 3 4
3. Check for the right patient, right medication, right time, right dose, ensure 0 1 2 3 4
patient’s right to know/consent and to refuse
4. Read the label on the package and compare with patient’s treatment sheet 0 1 2 3 4
5. Remove the package, check the label of the packages and compare with 0 1 2 3 4
patient’s treatment sheet for the third time
6. Pour out water into a drinking glass or cup 0 1 2 3 4
7. Take tablet with spoon 0 1 2 3 4
8. Give tablet to patient and ensure that patient swallows it 0 1 2 3 4
9. Congratulate patient and make him/her comfortable in bed 0 1 2 3 4
10. Discard tray, wash and dry hands 0 1 2 3 4
11. Document procedure in the nurses’ note and chart on treatment sheet 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
ADMINISTRATION OF MIXTURE
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Identify and check for the right patient, right medication, right time, right dose, 0 1 2 3 4
ensure patient’s right to know/consent and refuse
2. Inform patient and send tray to bedside 0 1 2 3 4
3. Identify patient by mentioning the name and check with treatment sheet 0 1 2 3 4
4. Read the label on the package and compare with patient’s treatment sheet 0 1 2 3 4
5. Shake the bottle well 0 1 2 3 4
6. Remove the cork and hold it with little or ring finger, compare label on the bottle 0 1 2 3 4
a second time with patient’s treatment sheet
7. Pick the medicine glass and with the thumb nail, mark the level of the measure 0 1 2 3 4
to be taken
8. Pour out the prescribed dose at eye level in bright light by, holding the bottle 0 1 2 3 4
with the label uppermost
9. Replace the cork, read the label a third time, compare with patient’ treatment 0 1 2 3 4
sheet and dosage
10. Supervise patient to drink the medicine and serve water if necessary 0 1 2 3 4
11. Discard tray, wash and dry hands 0 1 2 3 4
12. Document procedure and sign treatment sheet 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
ADMINISTRATION OF IV MEDICATION (AMPOULE RECONSTITUTED MEDICATION)
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Establish rapport and explain procedure to the patient 0 1 2 3 4
2. Check the Physician’s order for the type of medication and the rights of
medication administration
3. Check the medication label and be sure before reconstituting as per
manufacturer’s instructions, especially expiry date
4. Wash, dry hands, reconstitute, examine for cloudiness and sediments 0 1 2 3 4
5. Draw medication and expel air from the barrel of the syringe 0 1 2 3 4
6. Protect bed linen with a dressing mackintosh and towel and position patient 0 1 2 3 4
comfortably
7. Wash, dry hands, wear gloves and clean entry port of cannula with methylated 0 1 2 3 4
spirit and cotton wool swab
8. Fixe syringe into the entry port of cannula and push medication slowly using the 0 1 2 3 4
push-stop-push-stop technique until is completed while observing patient for
any reaction
9. Continue observing patient even after injecting medication 5 to 10 minutes later 0 1 2 3 4
10. Encourage patient to inform the nurse for any adverse reaction 0 1 2 3 4
11. Thank patient and make him/her comfortable in bed 0 1 2 3 4
12. Remove dressing mackintosh, towel and discard used items 0 1 2 3 4
13. Wash, dry hands and record procedure on treatment chart and on the nurses’ 0 1 2 3 4
note
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
ADMINISTRATION OF RECTAL MEDICATION
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Identify patient by mentioning the name and check treatment sheet against 0 1 2 3 4
doctor’s order
2. Establish rapport and explain procedure to patient and encourage him/her to 0 1 2 3 4
empty bowel
3. Observe the right of medication administration 0 1 2 3 4
4. Send tray to bedside and provide privacy 0 1 2 3 4
5. Assist patient to left lateral or left sim’s position, with the upper leg flexed 0 1 2 3 4
6. Protect bed with dressing mackintosh and towel at the buttocks 0 1 2 3 4
7. Fold back the top bed clothes to expose the buttocks 0 1 2 3 4
8. Wash, dry hands, don gloves and clean anal area with cotton wool swab 0 1 2 3 4
9. Remove gloves, wash and dry hands 0 1 2 3 4
10. Remove medication, check label and compare with patient’s treatment sheet 0 1 2 3 4
the third time
11. Wear gloves, unwrap the suppository, encourage patient to relax by breathing 0 1 2 3 4
through the mouth
12. Insert the suppository gently into the rectum using gloved index finger and press 0 1 2 3 4
the patient’s buttocks together for few minutes
13. Ask the patient to remain in the left lateral or supine position at least for five 0 1 2 3 4
(5) minutes or according to manufacturer’s instruction
14. Congratulate patient and make him comfortable in bed 0 1 2 3 4
15. Remove gloves, clear tray, wash and dry hands 0 1 2 3 4
16. Document procedure on treatment sheet and nurses’ notes
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
PREPARING TRAY AND GIVING INTRAMUSCULARE (IM) INJECTION
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Identify and check for the right patient, right medication, right time, right dose, 0 1 2 3 4
ensure patient’s right to know/consent and refuse
3. Prepare and take tray to patient’s bedside 0 1 2 3 4
4. Check details again with patient’s treatment sheet 0 1 2 3 4
6. Assemble syringe and needle using sterile technique 0 1 2 3 4
7. File and break ampoule or remove metal cap of vial with a clean swab, draw 0 1 2 3 4
medication and discard
8. Replace needle with a new one and expel air 0 1 2 3 4
9. Assist patient into required position and expose site for the injection 0 1 2 3 4
10. Clean injection site with swab dipped in antiseptic lotion (i.e. upper outer 0 1 2 3 4
quadrant for buttocks and outer aspect of thigh
11. Insert the needle quickly and firmly deep into the muscle at right angle 0 1 2 3 4
12. Withdraw piston a little to ensure needle is not in the blood vessel (if blood 0 1 2 3 4
appear withdraw needle)
13. Push to release medication into the tissue 0 1 2 3 4
14. Withdraw the syringe and needle quickly and with a swab, gently apply pressure 0 1 2 3 4
to the site of injection
15. Discard syringe and needle into a safety box 0 1 2 3 4
16. Thank patient and leave him/her comfortably in bed 0 1 2 3 4
17. Wash and dry hands, document any findings and sign treatment sheet 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
SETTING UP I.V. INFUSION
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

1. Explain procedure and its purpose to patient and reassure him/her 0 1 2 3 4
2. Check the Physician’s order for the type of solution and check the rights of 0 1 2 3 4
medication administration
3. Ensure quality of the infusion (check for cloudiness, sediments, other particles 0 1 2 3 4
and expiry date)
4. Send prepared trolley and other equipment to the patient’s bedside 0 1 2 3 4
5. Encourage patient to use bedpan, check vital signs and record 0 1 2 3 4
6. Select and inspect site and shave if necessary 0 1 2 3 4
7. Place infusion stand at the side of the bed and prepare plaster strips/tape 0 1 2 3 4
8. Insert the piercing needle of giving set into rubber seal of the infusion 0 1 2 3 4
bag/bottle
9. Hang the bottle/bag on the drip stand 0 1 2 3 4
10. Remove the cap from the other end of the giving set and attach needle to it 0 1 2 3 4
11. Protect the bed with dressing mackintosh and dressing towel 0 1 2 3 4
12. Fill the chamber half way and expel the air from the giving set 0 1 2 3 4
13. Wash hands, dry and wear sterile gloves and clean the site with antimicrobial 0 1 2 3 4
solution (methylated spirit) with cotton swab
14. Ask assistant to apply tourniquet to locate the vein 0 1 2 3 4
15. Discard syringe and needle into a safety box 0 1 2 3 4
16. Thank patient and leave him/her comfortably in bed 0 1 2 3 4
17. Wash and dry hands, document any findings and sign treatment sheet 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

CENTRE……………………………………………………………………………………………… DATE…….………………….
TEPID SPONGING
REQUIREMENTS:
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………..

2. Prepare trolley and send to the bedside 0 1 2 3 4
4. Take patient's temperature, pulse and respiration and record 0 1 2 3 4
5. Arrange top bed clothes leaving top sheet 0 1 2 3 4
6. Protect bottom sheet and undress the patient 0 1 2 3 4
7. Wash and dry face to refresh patient 0 1 2 3 4
8. Leave a flannel rung out of cold water on the patient's forehead 0 1 2 3 4
9. Place 6 pieces of flannel into basin or tepid water 0 1 2 3 4
10. Place a wet flannel in each axilla and groin, squeeze out excess water 0 1 2 3 4
11. Change the wet flannel frequently to keep them tepid 0 1 2 3 4
12. Sponge upper arms, trunk, lower limbs and back in strokes leaving small drops 0 1 2 3 4
of water on the skin
13. Change water as often as necessary 0 1 2 3 4
14. Leave patient for 15-20 minutes 0 1 2 3 4
15. Dress patient up, recheck temperature and record 0 1 2 3 4
16. Thank and makes patient comfortable 0 1 2 3 4
17. Wash, dry hands and serves cold drink if necessary 0 1 2 3 4
18. Document procedure and reports findings 0 1 2 3 4
SCORE OBTAINED………………………………………………………………………………………………………………………………….

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CANDIDATE’S NUMBER…………………………………………………. SIGN. OF CAND………………………...……….

MAKING A SIMPLE UNOCCUPIED BED

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

MAKING AN ADMISSION BED

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

MAKING AN OPERATION BED

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

MAKING A CARDIAC BED

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

CHANGING BOTTOM SHEET OF A PATIENT FROM TOP TO BOTTOM

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

CHANGING BOTTOM SHEET OF A PATIENT FROM SIDE TO SIDE

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

ADMISSION OF A PATIENT (AMBULANT)

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

ADMISSION OF A CHILD (AMBULANT)

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

ADMISSION OF A SERIOUSLY ILL CHILD

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

DISCHARGING A PATIENT FROM THE HOSPITAL

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

ORIENTATION OF PATIENT TO THE WARD ENVIRONMENT (AMBULANT)

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

EDUCATING A PATIENT ON CONDITION

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

EDUCATING A PATIENT ON MEDICATION PRIOR TO DISCHARGE

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………

HANDING OVER THE WARD

COMPONENT TASK RATING

NAME OF EXAMINER…………………………………………………………………… SIGNATURE…………………………….

RANK OF EXAMINER……………………………………………………………………. DATE………………………………………