University of the Philippines Manila

The Health Sciences Center

COLLEGE OF NURSING
World Health Organization Collaborating Center for Leadership in Nursing Development
CHED Center of Excellence
Sotejo Hall, Pedro Gil Street, Ermita, Manila
Tel. # 523-14-77 Telefax # 523-14-85
Email: cn@post.upm.edu.ph Website: http://cn.upm.edu.ph

SUMMARY PERFORMANCE EVALUATION ACHIEVING

INTRA-OPERATIVE CARE COMPETENCY
In Accordance with PRC Board of Nursing Memorandum No. 01 series 2009

Signature over Printed Name of Student: JAY LEMUEL J. BUENVIAJE

DESIRED 1ST 2ND 3RD AVERAGE

INTRA-OPERATIVE COMPETENCIES
RATING RLE RLE RLE RATING
I. SAFE AND QUALITY NURSING CARE (SQC)
1. Utilizes the nursing process in the care of OR Client
a. Obtains comprehensive client’s information by 4 4 4 4 4
checking complete accomplishment of the
preoperative checklist/client’s care
b. Identifies priority needs of the client at the Operating 4 4 4 4 4
Room
c. Provides needed nursing Interventions based on 4 4 4 4 4
identified needs
d. Monitors client’s responses to surgery 2 2 2 2 2
2. Promotes safety and comfort of patient based on OR 2 2 2 2 2
3. Performs the functions of the scrub nurses

a. Performs surgical scrub correctly 4 4 4 4 4

b. Wears sterile gowns and gloves aseptically 2 2 2 2 2

c. Prepares surgical instruments, sponges, sutures and 2 2 2 2 2

other supplies in functional arrangements
d. Hands instruments, sponges, sutures, and other 2 2 2 2 2
needed materials according to surgeon’s preference
e. Performs surgical count accurately 2 2 2 2 2

4. Performs the function of the circulating nurse

a. Anticipates the needs of the circulating nurse 2 2 2 2 2
b. Sets up the OR room and needed equipment 2 2 2 2 2
c. Receives client for surgery / endorses client post- 2 2 2 2 2
operatively
d. Assists in skin preparation and draping of client 2 2 2 2 2
5. Administers medications and other health therapeutic 2 2 2 2 2
safety
II. MANAGEMENT OF RESOURCES AND ENVIRONMENT (MRE)
1. Organizes work load to facilitate timely patient care 4 4 4 4 4
2. Utilizes adequate and appropriate resources to support 2 2 2 2 2
the OR Team
3. Ensures functionally of OR resources 2 2 2 2 2
4. Maintains a safe environment at the OR by observing the 2 2 2 2 2
principles of asepsis
III. HEALTH EDUCATION (HE)
1. Implements appropriate health education activities to 2 2 2 2 2
client based on needs assessment

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IV. LEGAL RESPONSIBILITIES (LR)
1. Adheres to legal institutional protocols regarding 2 2 2 2 2
informed consent
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respect the rights of the OR clients 2 2 2 2 2
2. Accepts responsibility and accountability for own 2 2 2 2 2
decisions and actions as an OR nurse
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Performs OR functions according to professional 4 4 4 4 4
standards
2. Possesses positive attitude towards learning surgical and 2 2 2 2 2
OR-related knowledge and skills
VII. QUALITY IMPROVEMENT (QI)
1. Participates in quality improvement activities related to 2 2 2 2 2
infection and successful OR operations
2. Identifies and reports variances in sterility and other OR 2 2 2 2 2
activities
VIII. RESEARCH (R)
1. Disseminates results of OR-related research findings to 2 2 2 2 2
clinical group and other members of the OR team as
appropriate
IX. RECORDS MANAGEMENT
1. Maintain accurate and updated documentation of patient 2 2 2 2 2
care
X. COMMUNICATION (Comm)
1. Establishes rapport with patients, significant others and 1 1 1 1 1
members of the health team
2. Uses appropriate information mechanisms to facilitate 2 2 2 2 2
communication inside the OR and with other departments
XI. COLLABORATION AND TEAMWORK (CTM)
1. Collaborates plan of care with other members of the 2 2 2 2 2
health team
TOTAL SCORE 75 75 75 75 75

Certified True and Correct:

(Signature over Printed Name)

__________________________________ __________________________________
ELENA T. DIZON, RN ALDIN D. GASPAR, MSc, MHC, MN, RN
Clinical Instructor Clinical Coordinator, N-107
License Number: 0307186 License Number: 0442123
PRC Card Validity Date: August 18, 2020 PRC Card Validity Date: May 14, 2022

___________________________________
CECILIA G. PEÑA, MN, RN
Deputy Director for Nursing, UP-PGH
License Number: 0109011
PRC Card Validity Date: Nov. 22, 2020
__________________________________
SHEILA R. BONITO, DrPH, MA, RN
Dean, UP College of Nursing
License Number: 0241045
PRC Card Validity Date: Feb. 11, 2021

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