EMILIO AGUINALDO COLLEGE

1113-1117 San Marcelino, St. Paco Manila

School of Nursing

PERFORMANCE EVALUATION TOOL

ACHIEVING COMPETENCY IN Performing perineal care
Procedure:
NAME OF STUDENT: ____________________________________________________________
SECTION/GROUP

: _________________________________ Date: _______________________

PREPARATION

LEGEND:
5

Gathers corrects and complete supplies and equipment.

Collects 1 inappropriate supply and equipment and/or lacks 1 supply and equipment.

Collects 2 inappropriate supplies and equipment and/or lacks 2 supplies and equipment.

Collects 3 or more inappropriate supplies and equipment and/or lacks 3 or more supplies and
equipment.

Fails to gather correct and complete supplies/equipment.

Preparation
1.

Gather equipment

1. Gloves( non- sterile)

2. Sponge cloth

3. Basin with warm water

4. Waterproof pad or gauze

5. Towels

6. Mackintosh

7. Soap with soap dish

REMARKS

8. Toilet paper

9. Bed pan as required

PROCEDURE

LEGEND:
4

Very Satisfactorily Performed

(Student performs consistently in an effective and efficient manner)

Satisfactorily Performed
(Performance is usually effective and efficient but not always)

Fairly performed
(Progress in performances too slow to judge satisfactorily; task performances not properly for majority
of the time)

Poorly performed
(No progress in performance has been demonstrated, and or performance is consistently inefficient)

Procedure
1.

Introduce yourself, and verify the clients identity. Explain to the

client what you are going to do, why it is necessary and how the
client can cooperate.

Perform hand hygiene, and observe other appropriate infection

control procedures

Provide client privacy.

2.
Raise the bed to a comfortable height if possible
3. Preparation the position:
1) Uncover the client's perineal area.
2) Place a mackintosh and towel ( or waterproof pad) under the client's

REMARKS

hips
4 Cleanse the thighs and groin:
1) Make a mitt with the sponge cloth.
2) Cleanse the client's upper thighs and groin area with soap and water.
3) Rinse and dry.
4) Wash the genital area next.

5.
Female client:

Use a separate portion of the sponge towel for each stroke

Change sponge towel as necessary.

Separate the labia and cleanse downward from the pubic to anal
area.

Wash between the labia including the urethral meatus and vaginal
area.

Rinse well and pat dry.

6.
Male Client:

Gently grasp the clients penis.

Cleanse in a circular motion moving from the tip of the penis

backwards toward the pubic area

In an uncircumcised male, carefully retract the foreskin prior to

washing the penis.

Return the foreskin to its former position.

Wash, rinse, and dry the scrotum carefully

7 Assist the client to turn on the side. Separate the client's buttocks and
use toilet paper, if necessary, to remove fecal materials.
8. Cleanse the anal area, rinse thoroughly, and dry with a towel.
Change sponge towel as necessary.
9. Apply skin care products to the area according to need or doctor's order

10. Return the client to a comfortable position.

11 Remove gloves and perform hand hygiene.
11

Document the procedure, describing the client's skin condition.

Sign the chart.

Grading system
Performance Score

_______x 90%=______

Punctuality and Grooming

_______x 10%=______
Total = ______

Evaluated by:

_______________________________
Faculty's Signature over printed name

Confirmed by:

___________________________
Student's Signature over printed name