OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Valenzuela Campus

PROGRAM Bachelor of Science in Nursing STUDENT NAME

NCMA 217 RLE YEAR AND SECTION
Care of Mother and Child and INSTRUCTOR
COURSE
Adolescent (Well Client)
SKILLS LABORATORY DATE

PROCEDURE : ADMINISTERING PERILIGHT THERAPY

EXPECTED OUTCOME : The student should be able to administer perilight therapy correctly.
ASSESSMENT TASK : Return Demonstration
Exceptional Good Average Poor
Assessment Dimension SCORE
(4) (3) (2) (1)
1. Verify doctor’s Verified the doctor’s Verified the doctor’s Verified the doctor’s Failed to
order. order order with minimal order incorrectly verify the
error doctor’s order
2. Gather equipment. Gathered the materials Gathered the materials Gathered materials with Failed to
Ensure lamp is needed completely with little time more time preparation gathered all
working. preparation the materials
needed
3. Explain procedure. Explained the procedure Explained the Explained the procedure Failed to
Provide privacy to the client and procedure but lacks but in an unclear manner explain the
significant others clearly details procedure
and completely with
approval
4. Position client in Performed the procedure Performed but needs Performed with slight Failed to
dorsal recumbent accurately with evident minimal supervision difficulty, needs perform the
position ease without supervision supervision most of the procedure
time
5. Do proper draping Performed the procedure Performed but needs Performed with slight Failed to
(diamond fashion accurately with evident minimal supervision difficulty, needs perform the
draping) ease without supervision supervision most of the procedure
time
6. Administer the Performed the procedure Performed but needs Performed with slight Failed to
perilight therapy accurately with evident minimal supervision difficulty, needs perform the
ease without supervision supervision most of the procedure
time
7. Place the patient in Demonstrated the Demonstrated the Demonstrated the Failed to
comfortable procedures with ease procedure with little procedure with some perform the
position after the errors errors procedure
procedure
8. After care of the Performed the procedure Performed but needs Performed with slight Failed to
materials used accurately with evident minimal supervision difficulty, needs perform the
ease without supervision supervision most of the procedure
time
9. Do handwashing Washed hands and Washed hands and Washed hands but most Washed
and document. documented the some of the details of of the details of the hands but
information about the procedure were not procedure were not documentatio
procedure properly and documented. documented n was not
completely. done.

SCALE:
4 – (EXCEPTIONAL) Works competently and independently at all times
3 – (GOOD) Requires minimum guidance and supervision
2 – (AVERAGE) Requires frequent guidance and supervision
1 – (POOR) Requires close guidance and supervision most of the time

OVERALL SCORE: ________________

Target raw score: 27 out of 36. If raw score is less than 27, repeat the demonstration

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FACULTY SIGNATURE OVER PRINTED NAME STUDENT NURSE SIGNATURE OVER PRINTED NAME

COLLEGE OF NURSING – VALENZUELA CAMPUS 1