Republic of the Philippines

Palawan State University

Puerto Princesa City
College of Nursing and Health
Sciences
BAG TECHNIQUE
Performance Assessment Checklist
Name of student: ___________________________ Date performed: __________
Steps Remarks
Done Not Done

1. Upon arriving at the client’s home, place the bag on the table or any flat
surface lined with paper lining. Position your paper lining in such a way that
the dirty side (outer part) will be touching the table.

2. Fold the handle or strap beneath the bag and ensure that the bag will only
touch the clean side of the paper lining.

3. Prepare a basin of water and an extra glass or dipper if there is no

available faucet. Place these away from your chosen work area.

4. Open the bag to take out the plastic lining. Spread it over your chosen
work area or field, ensuring that the clean side (inner part of the plastic) is
out.

5. Proceed to take out hand towels (leave its plastic container inside the bag),
soap, paper bag and apron. Place these articles at one corner of your work
area (except the paper bag which should be placed outside the work field and
away from the handwashing area), ensuring that everything is within the
confinement of the plastic lining.

6. Perform handwashing and wipe your hands appropriately using one of

your towels. Place the used towel inside the paper bag.

7. Put on apron, ensuring that the clean side is out; slip the neck strap over
your head before tying the lower straps around your waist.

8. Get the rest of the things you will need from the bag for your assessment
or nursing care procedure and place at one corner of your work field (ex.

Prepared by: Johnard B. Rebato/Jhoanna V. Tabi

 thermometer, kidney basin, cotton, alcohol). Be careful not to touch the
outer part of the bag when you are taking out the the articles.

9. Close the bag.

10. Proceed in performing specific nursing care or treatment

11. After completing the procedure, clean used articles with alcohol.

12. Perform handwashing

13. Open the bag and put back all disinfected articles in their proper places

14. Remove apron, folding away from the body (soiled side should be folded
inwards. Place your used apron in a separate paper bag.

15. Clean your plastic lining with soap and water or cotton with alcohol.
Place it outside the flaps of your bag. Then close the bag.

16. Make proper documentation and discuss the result of your assessment
and/or the outcome of your nursing care with the mother.

17. Make appointment for the next visit and bid the client goodbye.

18. Get the bag from the table, fold the paper lining, and insert in the
pocket of your bag then leave.

Comments:
______________________________________________________________________________
______________________________________________________________________________
_______________________________
Student’s printed name and signature

__________________________________________
Clinical Instructor’s printed Name and Signature

Prepared by: Johnard B. Rebato/Jhoanna V. Tabi