OUR LADY OF FATIMA UNIVERSITY

College of Nursing

PROGRAM Bachelor of Science in Nursing STUDENT NAME

COURSE NCM-101 YEAR & SECTION
(Promoting Urinary and Bowel INSTRUCTOR
Elimination)
DATE

ASSESSMENT RUBRICS FOR RETURN DEMONSTRATION

Write the score on the corresponding box on the following grading criteria:
5-Activity performed accurately with evident ease without supervision
4-Activity performed but needs minimal supervision
3-Activity performed with slight difficulty, needs supervision most of the time
2-Activity performed inaccurately
1-Activity not performed

PROCEDURE: Male Catheterization

EXPECTED OUTCOME: The student should be able to perform catheterization on a male patient correctly
ASSESSMENT TASK: Return Demonstration

Assessment Dimension (5) (4) (3) ( 2) ( 1)

1. Assess the patient’s need for catheterization and refer patient to the doctor.
2. Verify the doctor’s order for catheterization.
3. Prepare the necessary materials.
4. Perform hand washing.
5. Identifies the patient and explains the procedure.
6. Positions the patient properly and ensures patient’s privacy.
7. Applies aseptic technique during the entire procedure.
8. Opens the catheterization kit aseptically.
9. Add materials to the kit ensuring sterility the whole time.
10. Dons first glove and fills the syringe with distilled water.
11. Dons second glove and applies sterile drapes to the patient.
12. Grabs the penis firmly behind the glans with the non-dominant hand and retracts
the foreskin of the uncircumcised male.
13. With the dominant hand, uses sterile forcep to pick up swabs. Cleans first from
the meatus and then wipe the tissue surrounding the meatus in circular motion using a
new swab for each stroke.
14. Picks up the catheter and places the drainage end of the catheter in the urine
receptacle using uncontaminated hand.
15. Lubricates the insertion end or tip of the catheter.
16. Lifts the penis to a position at 90 degrees angle and inserts the catheter until urine
flows.
17. Connects the catheter to the urine bag and ensures that emptying base of the bag is
closed.
18. Inflates the balloon by injecting 5-10cc of distilled water and checks the anchor.
19. Tapes the catheter with non-allergenic tape at the lower abdomen of the patient.
20. Removes drapes and makes the patient comfortable.
21. Disposes soiled materials properly.
22. Accurately records the procedure done.
SCORE: (_______/110)*100 = ________Target Raw Score:83 out of 110 If raw score is less than 83, repeat the demonstration.

______________________________________________________
CI SIGNATURE OVER PRINTED NAME

Prepared by: EVANGELINE F. ORATA RN. RM. MAN Noted by: FRANCIS S. VASQUEZ RN. MAN.
ROSANA P. SUVA RN. MAN. Coordinator
MELANIE S. CAMBEL RN. MAN.

Approved by: LURCELI L. SANTOS RN. MAN

Dean, College of Nursing