Name: Year and section:

Dimension/Criteria 4-Exemplary 3-Accomplished 2-Developing 1-Beginning Remarks

Effective Detection

Patient identification Asks patient's name and date of birth and looks at identification tag.

Asks either patient's name or date of birth and looks at identification tag.

Verifies patient using only one identifier.

Did not identify the patient.

Focused observation

Focuses observation appropriately; regularly observes and monitors a wide variety of objective and subjective data to uncover any useful information.

Regularly observes and monitors a variety of data, including both objective and subjective; most useful information noticed; may miss the most subtle signs.

Attempts to monitor a variety of objective and subjective data but is overwhelmed by the array of data; focuses on the most obvious data, missing some important information.

Confused by clinical situation and the amount and kind of data; observation is not organized and important data are missed; assessment errors are made.

Effective Preparation

Equipment and supply preparation

Selects and prepares all equipment and supplies prior to peritoneal dialysis.

Selects and prepares most equipment and supplies prior to peritoneal dialysis.

Selects and prepares some equipment and supplies prior to peritoneal dialysis.

Selects and prepares inadequate or inappropriate equipment prior to peritoneal dialysis.

Effective Execution

Clear communication Communicates effectively; explains interventions; calms and reassures patients and families; directs and involves team members, explaining and giving directions; checks for understanding.

Generally communicates well, explains carefully to patients, gives clear directions to team; could be more effective in establishing rapport.

Shows some communication ability (e.g., giving directions); communications with patients, families, and team members are only partly successful; displays caring but not competence.

Has difficulty communicating, explanations are confusing, directions are unclear or contradictory, patients and families are made more confused or anxious and are not reassured.

Dimension/Criteria 4-Exemplary 3-Accomplished 2-Developing 1-Beginning Remarks

Well-planned intervention/flexibility

Interventions are tailored for the individual patient; monitors patient progress closely and is able to adjust treatment as indicated by patient response.

Develops interventions on the basis of relevant patient data; monitors progress regularly but does not expect to have to change treatments.

Develops interventions on the basis of the most obvious data; monitors progress but is unable to make adjustments as indicated by the patients response.

Focuses on developing a single intervention, addressing a likely solution, but it may be vague, confusing, and/or incomplete; some monitoring may occur.

Technique Shows mastery of

necessary nursing skills Displays proficiency in the use of most nursing skills; could improve speed or accuracy

Is hesitant or ineffective in using nursing skills

Is unable to select and/ or perform nursing skills

Asepsis Hand hygiene was performed; Dialysate bottle was disinfected before spiking; Maintained sterile insertion site and equipment throughout the procedure.

Errors were made in maintaining sterility of tubing and/or equipment, but self-corrected.

Unrecognized errors made in maintaining sterility of tubing and/or equipment.

Contaminated tubing and/or equipment during procedure.

Procedure efficiency Disciplined use of time and resources, performed skill in the minimum suggested simulation time expectation (SSTE).

Organized and able to perform the skill within the SSTE.

Disorganized but met the maximum SSTE.

Disorganized and exceeded the maximum SSTE.

Effective reflection-reaction

Evaluation and self-analysis

Independently evaluates and analyzes personal clinical performance, noting decision points, elaborating alternatives, and accurately evaluating choices against alternatives.

Evaluates and analyzes personal clinical performance with minimal prompting, primarily about major event or decisions; key decision points are identified, and alternatives are considered.

Even when prompted, briefly verbalizes the most obvious evaluations; has difficulty imagining alternative choices; is self-protective in evaluating personal choices.

Even when prompted, evaluations are brief, cursory, and not used to improve performance; justifies personal decisions and choices without evaluating them.

Total score:_____/36 Passed Failed Lecturer:

Signature over printed name Date

Prepared by: Cara Jaye Garcia, RN MAN & Les Paul Valdez, RN MAN