ARELLANO UNIVERSITY

COLLEGE OF NURSING
1058 Taft Avenue, Pasay City

EVALUATION TOOL

Assisting Client during Ambulation with Assistive Devices

NAME: _____________________________________________________DATE: ____________________SCORE: __________

SCORE
CRITERIA
4 3 2 1
I. ATTITUDE – 10%
1. Report on time
2. Wears complete prescribed uniform
3. Neat and well-groomed
4. Observes proper decorum
5. Acknowledges criticism/ suggestions cheerfully
6. Shows mastery of the activity
TOTAL = 24
II. KNOWLEDGE – 20%
1. States objectives of the activity
2. Uses appropriate terms
3. States steps of the procedure in correct order
4. Explains rationale of the steps
TOTAL = 16
III. SKILLS COMPETENCY – 70%

1. Check the physician’s order (Rationale: Ensures correct patient)

2. Gather the materials needed (Rationale: Organizes work)

3. Greet the patient and explain procedure to the client. (Rationale: Allay anxiety and
gain cooperation of the patient
4. Wash hands (Rationale: Reduces the transmission of microorganisms)
5. Obtain non –skid shoes & clear floor of litter & spills (Rationale: Ensures the
safety of the patient)

Using a Cane

a. Assess client for strength, mobility, range of motion, visual acuity perceptual
difficulties and balance. (Rationale: Helps determine the: Capabilities of client and amount
of assistance required.
b. Adjust cane to fit the client.
c. Canes should have a rubber tip. (Rationale: Rubber tip prevents client from slipping)
d. Handle should be at the level of the client’s greater trochanter.
e. Instruct client how to hold the cane. Client’s elbow should be flexed at 15 to 30 angle
The cane should be held 4 to 6inches lateral to the foot. Cane should be held by the hand
on the unaffected side.
f. Instruct the client to move the cane at the same time as the affected leg.

Using a walker

A. Sitting to standing position:

1. Place walker in front of seat.

2. Put both hands on armrests of the chair and push up to a standing position.
3. Move hands to walker one at a time.
4. Handgrips should reach slightly below waist level for comfort.
5. Elbows should be slightly flexed for better support.
6. Nurse stands next to and slightly behind the affected side.

B. Walking using walker:

1. Move walker forward using both hands.
2. Put weight on both arms and walk into the walker.
3. Repeat pattern.

C. Standing to sitting position:

1. Turn your back to the chair.
2. Step back until the popliteal area of the well leg touches the front edge of the chair.
3. Using the hand ipsilateral to the unaffected side reach for the armrest.
4. Lower self onto chair

Using crutches.

A. Sitting to standing position:

1. Place feet securely on the floor.

2. Hold crutches using the hand ipsilateral to the affected side.
3. Using the hand opposite the affected side, hold onto the armrest of the chair.
4. Put weight on the unaffected leg and stand while holding onto the crutches and the
armrest.

B. Positioning the crutches:

1. Place crutches 2 to 3 finger- breadths under the axilla.

2. Place the crutch tips 6 to 10 inches diagonally in front of and lateral to both feet.
C. Gait Pattern:

1. Four-point gait:

a. Move left crutch forward.

b. Move right leg forward.
c. Move right crutch forward.
d. Move left leg forward.
e. Repeat pattern.

2. Three-point gait:

a. Move crutches and affected leg forward while bearing weight on the unaffected leg.
b. Put weight on both arms and move the well leg forward to the level of the other foot.
c. Repeat pattern

3. Two-point gait:

a. Move left crutch and right foot.

b. Move right crutch and left foot.
c. Repeat pattern.

4. Swing-to gait:

a. Move both crutches forward.

b. Move both feet to the level of the crutches.

5. Swing-through gait:

a. Move both crutches forward

b. Move both feet past the level of the crutches.
 D. Standing to sitting position:

1. Turn your back to the chair.

2. Step back until the popliteal area of the well leg touches the front edge of the
chair.
3. Hold the crutches using the hand ipsilateral to the affected side.
4. Using the hand ipsilateral to the unaffected side, reach for the armrest.
5. Lower self onto chair.

Evaluation

1. Compare pre-ambulation and post-ambulation vital signs.

2. Check fatigue or pain level.
3. Ask how the patient feels.
4. Evaluate overall strength, balance, and ability to ambulate.
5. Evaluate use of assistive device.

10. Documentation

Document according to facility policy.

GRADING SYSTEM: ATTITUDE 10%

KNOWLEDGE 20%
SKILLS 70%

RATE THE STUDENT FROM 1-4 WHERE;

4 – Very Satisfactory exhibits competency independently
3 – Satisfactory exhibits competency with minimal supervision
2 – Fair exhibits competency fairly with close supervision
1 – Needs Improvement did not exhibit competency

FORMULA FOR GETTING THE GRADE PERCETAGE:

ATTITUDE (PERFECT SCORE: 24) Grade Percentage = raw score x 60 + 40 x 10%
Perfect score
KNOWLEDGE (PERFECT SCORE: 16) Grade Percentage = raw score x 60 + 40 x 20%
Perfect score
SKILLS (PERFECT SCORE: __) Grade Percentage = raw score x 60 + 40 x 70%
Perfect score
FINAL GRADE = ATTITUDE + KNOWLEDGE + SKILLS

REMARKS / SUGGESTIONS:

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Clinical/ Instructor’s Signature over Printed Name & Date Student’s Signature Over Printed Name & Date