Student Skill Self Assessment 20063.30.06Name ________________ College, (Specify Associate or Baccalaureate) Degree ProgramDate _________________ Nursing Student Intern Self Assessment of Skills 2006

Direction: During your internship, you will be working with a preceptor/mentor. This tool has been designed to communicate to your preceptor/mentor(s) the clinical skills you have been taught and your experience with these skills. Faculty from your school have identified which of these skills they have observed their students performing in the laboratory setting and skills that have only been discussed in class. Please check the appropriate box(es) for the clinical skills listed below. Bring the completed form with you to the first meeting with your preceptor/mentor.

School Completes Student Completes

Students have been observed performing this skill in the laboratory setting

Students have only had theory on this skill

Observed on or with a patient

Have performed with assistance

Performs Independently

Circulatory SystemAssess heart sounds Vital Signs

Apical pulse Radial pulse Manual BP Orthostatic BP

Assesses peripheral perfusion Assesses presence & quality of

peripheral pulses Assess capillary refill of extremities Assess skin temperature and color Edema

Apply peripheral circulation devices and assessment of effectiveness

Ted stockings Ace bandages Sequential compression devices

Pulmonary SystemAuscultation of lung sounds

Crackles Rales Diminished Absent

Assess respiratory rate and rhythmInspects sputum for color, quality and amountTurn, cough and deep breathIncentive spirometerPercussion/vibrationOral suction of a patientUse a mouth to mask recessitative deviceApnea monitor

Students Students Observed Have Performs

Adapted from FUMC Skill Inventory List, 2003

Student Skill Self Assessment 20063.30.06

School Completes Student Completes

have been observed performing this skill in the laboratory setting

have only had theory on this skill

on or with a patient

performed with assistance

Independently

Pulse oximeterSuction tracheotomyTrach careChest tube

Examine chest tube system for water seal, suction and airleak

Totals output of chest tube drain Dressing change of a chest tube

Gastrointestinal SystemPerforms a basic assessment of abdomen:

Symmetry Size Distention Firmness Pain

Measures abdominal girthPerforms a basic assessment of bowel function

Bowel sounds Flatus Stool color Consistency of stool

Give an enemaPlaces nasal gastric tube `Checks nasogastric tube placementCheck NG fluid pHPlaces a rectal pouchCares for a rectal pouchAssess stomasEmpties colostomy/ileostomyEmpty T-tubeAssist with oral feedingCalorie countsCares for a patient with a tube feeding:

Check placement Check patency

Cares for a patient with a gastrotomyCare for a patient with jejunostomyCare of patient with a PEGBlood glucose monitoringRenal SystemPerforms daily weights

Standing scale Liter scale Chair scale

Assess urine for Color

Students have been observed

Students have only had theory

Observed on or with a patient

Have performed with

Performs Independently

Adapted from FUMC Skill Inventory List, 2003

Student Skill Self Assessment 20063.30.06

School Completes Student Completes

performing this skill in the laboratory setting

on this skill

assistance

Odor Specific gravity Multistix Amount

Accurately measure intake and outputPlace Foley catheterPerforms Foley catheter carePlace condom catheterCare for a superpubic catheterCare for ureteral stintsCare of ileal conduitCares for continuous bladder irrigationCollect UA/UCCare for fistulaNeurological SystemPerform a neurological assessment on patient

level of consciousness orientation verbal response motor response response to pain PERLA Follow commands Relexes (cough and babinski)

Skeletal/ Muscular SystemsUses correct body mechanicsProperly position and turn Transfer patient to chair from bedUse a transfer beltPerforms PROM and AROMApplies traction appropriatelyCare for a patient with a castUses immobilizerCan assist patient with walker, cane or crutchesIntegumentary SystemSkin assessment

Color, moisture, tugor Breakdown and pressure areas Incisions staple, stitches, Infection of incision

Eye irrigationCare for abdominal wounds

Sterile dressing change Irrigation and packing

Assess wounds tissue appearance, color, presence of odor, size and location

Students have been observed performing

Students have only had theory on this

Observed on or with a patient

Have performed with assistance

Performs Independently

Adapted from FUMC Skill Inventory List, 2003

Student Skill Self Assessment 20063.30.06

School Completes Student Completes

this skill in the laboratory setting

skill

Peripheral edema Inspect sacral, ankles, feet, abd,

periorbital Palpate and rate edema

Heat therapy (aqua K)Cold therapy (ice bags)BathingOral hygieneShampoo hair while pt in bedShaveBack messageBedmakingImmune SystemWash hands before entering and leaving pt roomAssesses local signs of infection: redness, swelling and painAssess systemic physical signs related to immune functionDemonstrates appropriate precautions for infectionFollows Standard precautionsRecognize and adapt behavior based on type of isolation precautionsAdditional SkillsTime management skillAbility to prioritize patient careImplement the chain of command in the hospital

Adapted from FUMC Skill Inventory List, 2003