LIPA CITY COLLEGES College of Nursing (G.A. Solis St., Lipa City, (0 !"#$%&$'# , (((.lipa)ity)olleges.net" S*++A,Y PE,-O,+ANCE E.

AL*ATION AC/IE.ING INT,A&OPE,ATI.E CA,E CO+PETENCY In A))or0an)e (it1 P,C 2oar0 of Nursing +e3oran0u3 No. 04 Series 500'

Signature over Printed Name of Student: SI+2A/AN, 6EL+A AG6AN 6ESI,E6 4ST ,LE 5N6 ,LE ,ATING SA-E AN6 7*ALITY N*,SING CA,E (S7C" Utilizes the nursing process in the care of OR client a. Obtains comprehensive clients information b chec!ing complete accomplishment of the preoperative chec!list"clients chart b. #dentifies priorit needs of the client at the Operating Room c. Provides needed nursing interventions based on identified needs d. $onitors clients responses to surger 5 Promotes safet and comfort of patients 5 inside the OR Performs the functions of the scrub nurse a. Performs surgical scrub correctl b. 'ears sterile go(ns and gloves 5 asepticall c. Prepares surgical instruments) 5 sponges) sutures and other supplies in functional arrangement d. *ands instruments) sponges) sutures 5 and other needed materials according to surgeons preference e. Performs surgical count accuratel 5 Performs the functions of the circulating 5 nurse a. ,nticipates the needs of the surgical team b. Sets up the OR room and needed 5 e-uipment c. Receives client for surger " endorses 5 client post .operativel d. ,ssists in s!in preparation and 5 draping of client ,dministers medications and other health 5 therapeutics safel +ANAGE+ENT O- ,ESO*,CES, EN.I,ON+ENT AN6 E7*IP+ENT (+,E" Organizes (or! load to facilitate timel patient 0are Utilizes ade-uate and appropriate 5 resources to support the OR team 1nsures functionalit of OR resources 5 $aintains a safe environment at the OR 5 b observing the principles of asepsis /EALT/ E6*CATION (/E" #mplements appropriate health education 5 activities to client based on needs assessment LEGAL ,ESPONSI2ILITIES (L," ,dheres to legal and institutional protocols 5 regarding informed consent ET/ICO&+O,AL ,ESPONSI2ILITIES (E+," Respects the rights of the OR client 5 ,ccepts responsibilit and accountabilit 5 for o(n decisions and actions as an OR nurse PE,SONAL AN6 P,O-ESSIONAL 6E.ELOP+ENT (PP6" Performs OR functions according to professional standards Possesses positive attitude to(ards 5 learning surgical and OR2related !no(ledge and s!ills 7*ALITY I+P,O.E+ENT (7I" A.E,AGE ,ATING

INT,A&OPE,ATI.E CA,E CO+PETENCIES I. 1.

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Participates in -ualit improvement 5 activities related to infection control and successful OR operations %. #dentifies and reports variances in sterilit 5 and other OR activities .III. ,ESEA,C/ (," 1. 3isseminates results of OR2related 5 research findings to clinical group and other members of the OR team as appropriate I8. ,ECO,6S +ANAGE+ENT (,+" 1. $aintain accurate and updated 4 documentation of patient care 8. CO++*NICATION (Co33" 1. 1stablishes rapport (ith patients) 5 significant others and members of the health team %. Uses appropriate information mechanisms 5 to facilitate communication inside the OR and (ith other departments in the hospital 8I. COLLA2O,ATION AN6 TEA+9O,: (CT+" 1. 0ollaborates plan of care (ith other 5 members of the health team TOTAL SCO,E #$

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0ertified 4rue and 0orrect:

+ILA 2. P*N;ALAN, ,N +AN Clini)al Instru)tor Li)ense Nu3<er= 04> >%' P,C Car0 & .ali0ity 6ate= April 504$

C/,ISTY 6. SAN6O.AL, ,N +AN Clini)al Instru)tor Li)ense Nu3<er= 0!%5$%! P,C Car0 ? .ali0ity 6ate= +ar)1 504%

A;ENIT/ L. L*PIG, ,N +AN Clini)al Coor0inator Li)ense Nu3<er= 0!!%5! P,C Car0 & .ali0ity 6ate= O)to<er 504

PONCIANO L. +ALA2ANAN, ,N +AN 6ean Li)ense Nu3<er= 00>'%%' P,C Car0 & .ali0ity 6ate= O)to<er 504$

,E2ECCA +. TO,,ES, ,N +AN C1ief Nurse Li)ense Nu3<er= 4'%$4> P,C Car0 ? .ali0ity 6ate= +ar)1 504$

504!&504 A)a0e3i) Year gra0uate0