DE LA SALLE LIPA
COLLEGE OF NURSING
Nursing Care Management 103
Procedural Checklist in
SCRUBBING GOWNING AND GLOVING
Name: ____________ Date: ______Year/Sec: ___
Rating:
General Objectives:
Given actual or simulated situations/conditions, the students will be able to perform and
discuss the aseptic practices, including scrubbing, gloving and gowning safely and accurately.
Specific Objectives:
1. Explain the concepts of medical and surgical asepsis.
2. Identify interventions to reduce the risks of infections.
3. Correctly implement aseptic practices while rationalizing each step in the procedure.
Item Descriptors Verbal Interpretation
Weight
1 Excellent Performed the procedure with great ease and confidence,
observing work ethics (prudent, accepts criticisms and
suggestions), able to rationalize scientifically and shows
diligence in documenting observations at all times .
0.75 Very Performed the procedure with less confidence, observing
Satisfactory work ethics (prudent, accepts criticisms and suggestions),
able to rationalize scientifically and shows minimal diligence
in documenting observations.
0.50 Satisfactory Performed the procedure but requires close supervision and
shows potential for improvement.
0.25 Needs Failed to perform the procedure, unable to function well and
Improvement needs repeated specific/ detailed guidance or direction.
CRITERIA:
I. Skills 1.0 0.75 0.50 0.25 Remarks
1. Scrubbing: Prepared all supplies/materials
needed. Don a surgical cap and put on a
disposable mask. Removed all jewelry, assess
the skin, wash the hands and arms according
to hand washing procedure.
2. Moisten brush lather fingertips; then scrub
the spaces under the fingernails 30 circular
strokes. Lather digits; scrub 20 circular
strokes on all four sides of each finger. Lather
palm, back of hand, scrub 20 circular strokes
on each surface.
3. Scrub the forearm. Divide your arm in three-
inch increments. Scrub 20 circular strokes on
all four sides; ending two inches above the
elbow. Repeat steps for the other arm,
discard the brush then rinse hands.
COLLEGE OF NURSING
Nursing Care Management 103
Procedural Checklist in
SCRUBBING GOWNING AND GLOVING
Name: ____________ Date: ______Year/Sec: ___
Rating:
General Objectives:
Given actual or simulated situations/conditions, the students will be able to perform and
discuss the aseptic practices, including scrubbing, gloving and gowning safely and accurately.
Specific Objectives:
1. Explain the concepts of medical and surgical asepsis.
2. Identify interventions to reduce the risks of infections.
3. Correctly implement aseptic practices while rationalizing each step in the procedure.
Item Descriptors Verbal Interpretation
Weight
1 Excellent Performed the procedure with great ease and confidence,
observing work ethics (prudent, accepts criticisms and
suggestions), able to rationalize scientifically and shows
diligence in documenting observations at all times .
0.75 Very Performed the procedure with less confidence, observing
Satisfactory work ethics (prudent, accepts criticisms and suggestions),
able to rationalize scientifically and shows minimal diligence
in documenting observations.
0.50 Satisfactory Performed the procedure but requires close supervision and
shows potential for improvement.
0.25 Needs Failed to perform the procedure, unable to function well and
Improvement needs repeated specific/ detailed guidance or direction.
CRITERIA:
I. Skills 1.0 0.75 0.50 0.25 Remarks
1. Scrubbing: Prepared all supplies/materials
needed. Don a surgical cap and put on a
disposable mask. Removed all jewelry, assess
the skin, wash the hands and arms according
to hand washing procedure.
2. Moisten brush lather fingertips; then scrub
the spaces under the fingernails 30 circular
strokes. Lather digits; scrub 20 circular
strokes on all four sides of each finger. Lather
palm, back of hand, scrub 20 circular strokes
on each surface.
3. Scrub the forearm. Divide your arm in three-
inch increments. Scrub 20 circular strokes on
all four sides; ending two inches above the
elbow. Repeat steps for the other arm,
discard the brush then rinse hands.
