JOSE RIZAL UNIVERSITY
College of Nursing and Health Sciences
Performance Checklist
Newborn Bath Care
Name of Student: Edwin Bren S. Magdaleno II Date: Oct. 19, 2023
Year/Section/Group No.: 2nd Year BSN-204N Grade: __________
Rate the student’s performance by checking the appropriate box using the following criteria:
5- Excellent Carries out procedure efficiently, systematically and independently
4- Very Satisfactory Carries out procedure efficiently and systematically but requires minimal guidance and supervision
3- Satisfactory Carries out procedure efficiently and systematically but requires moderate guidance and supervision
2- Fair Carries out procedure with close guidance and supervision
1- Poor Carries out procedure inefficiently and unsystematic
CRITERIA RATIONALE
A. KNOWLEDGE
1. Assess the infant is condition and wash hands. Determine the child's biophysical profile to recognize
and address the infant's needs. To avoid cross-
contamination.
2. Gather the equipment: To conserve time and energy through the bathing
a. Bath towel process.
b. Complete set of baby dress and diaper
c. Dry cotton balls
d. Wash cloth
e. Soap and soap dish
f. 2 big basin / baby bath tub
g. Warm water
h. Kidney basin
B. SKILLS
3. Place towel, laid out in diamond fashion on top of the table next to To have a location where the nurse can undress the
basin/bath tub. newborn safely and comfortably.
4. Remove all clothing except shirt and diaper. To expose the infant's sanitary bodily parts.
5. Wipe the eyes using a cotton ball moistened with water starting To limit microbial contamination and spread.
from the inner to outer canthus. Use new cotton ball for each eye.
6. Dip wash cloth. Make a mitt and wash the face, ears and neck. Make certain that the towel has been completely wet
Dry all areas thoroughly. with warm water. Ability to clean the infant's body
parts. To avoid getting excess water into the infant's
clothes.
7. Hold infant on one arm (Football Hold) over the basin/bath tub and To support the infant's body and to clean the infant's
wet hair. Soap own hands and lather to hair and scalp using physical parts adequately. To prevent soap from
gentle, circular motion. Splash water against head to rinse off. getting into the infant's eyes and causing discomfort
and irritation.
8. Place infant on towel and dry the head using the corners of the To get rid of unnecessary water.
towel.
9. Undress the infant. Wet upper extremities, front, back, buttocks To clean the infant's bodily components
and legs using wash cloth. Apply soap and lather. appropriately.
10. Pick up infant and slowly lower him into the basin/ bath tub to Remove any soap that has been applied to the
rinse off. infant's skin.
11. Support the infant while lifting him from the tub/basin by placing To support the infant's body and prevent falls.
your hand and arm around the infant. Cradling his head and neck
in your elbow.
12. Grasp his thigh with other hand. Dry infant’s body gently but To get rid of unnecessary water.
thoroughly.
13. A. For Female: To ensure the cleanliness of the infant's genitals.
1. Separate labia, and with cotton ball moistened with soap
and water cleansed downward one of each side.
2. Use new piece of cotton ball on each side.
B. For Male:
1. Retract foreskin and gently cleanse glans penis with a
cotton ball moistened with soap and water.
2. Use a new cotton ball on each side.
14. Check cord and dress infant. To prevent germ development, to offer warmth and
comfort, and to prevent hypothermia
15. Document the procedure done. Correct documentation guarantees the patient's
safety.
C. ATTITUDE
16. Shows responsibility by having a complete set of equipment
needed in the activity and shows interest in doing the procedure.
17. Displays courtesy and consideration in acknowledging criticisms
and suggestions by the Clinical Instructor.
18. Demonstrates integrity by doing the skill honestly, competently
and completely.
A. Knowledge - Total score / Total no of items x 60 + 40 = _____x .3= ______________
B. Skills - Total score / Total no of items x 60 + 40 = _____x .6= ______________
C. Attitude - Total score / Total no of items x 60 + 40 = _____x .1= ______________
TOTAL = ___________________
Clinical Instructor’s Comments / Suggestions:
_____________________________________________________________________________________________.
Students’ Comments / Suggestions:
_____________________________________________________________________________________________.
_______________________________ _________________________
Student’s name & signature C.I.’s name & signature
