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Urine Collection: - Clinical Instructor (Sign Over Printed Name)

The document is a performance evaluation checklist for urine collection procedures. It lists the steps for clean-catch midstream urine collection, which is done as part of prenatal assessments to check for urinary tract infections. The checklist rates students on a scale of 1 to 5 for 11 steps of the procedure, including explaining the process to the patient, having them clean the genital area, catching the midstream urine sample without contamination, and properly labeling and storing the sample.

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307 views2 pages

Urine Collection: - Clinical Instructor (Sign Over Printed Name)

The document is a performance evaluation checklist for urine collection procedures. It lists the steps for clean-catch midstream urine collection, which is done as part of prenatal assessments to check for urinary tract infections. The checklist rates students on a scale of 1 to 5 for 11 steps of the procedure, including explaining the process to the patient, having them clean the genital area, catching the midstream urine sample without contamination, and properly labeling and storing the sample.

Uploaded by

hey aadarsha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Ateneo de Zamboanga University

College of Nursing
PERFORMANCE EVALUATION CHECKLIST

Urine Collection

Name of Student: ________________________ Date Performed: __________________


Level & Section: _______________________
Legend (Rating Criteria):
5 – Expert (student performs all tasks proficiently and independently).
4 – Competent (student performs efficiently in an effective and efficient manner).
3 – Progress Acceptable (performance is usually effective and but not always).
2 – Needs Improvement (progress in performance is too slow to judge satisfactorily; task performance is not
most of the time).
1 – Progress Unacceptable (no progress in performance has been demonstrated, and or performance is
consistently ineffective and inefficient).
Collecting Urine: Clean-catch midstream – is a procedure likely to be done as part of the prenatal assessment of
the woman in order to rule out urinary tract infections.
Materials:
 Sponge soaked in a soap solution
 Sterile cup or sterile wide-mouthed bottle with cover

PROCEDURE 1 2 3 4 5
1. Explain the procedure and its reason
2. Instruct the client to first wash her hands thoroughly and be ready with the
sterile specimen container.
3. Sit backwards on the toilet seat, facing the water tank. Spread the labia and
keep the labia folds apart for cleansing and to prevent labial and vaginal
contamination of the specimen.
Instruct the woman to wash the perineal area with soap and water and rinse it
4. well.
Using sponges soaked in a soap solution, cleanse the area around the
5. urinary meatus, observing the “front to back” technique; rinse thoroughly.
6. While keeping the labia separated with her fingers, instruct the woman to void
forcibly and stop at the midstream.
7. The initial stream of urine is enough to flush the urethra of microorganism
that may result in a false-positive result.
8. Catch the midstream urine in a sterile cup or wide-mouth bottle that is made
sure not come in contact with the genitalia.
9. Screw the lid of the cup securely, keeping the inner portion of the lid sterile.
After hand washing, label the bottle with the patient’s name, plus the date
10. and time of voiding.
11. Bring the specimen bottle to the center or to the laboratory.
TOTAL

__________________________
Clinical Instructor
(Sign over printed name)

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