internship program clinical skills achievement logbook · nebulizer . page 6 of 41 kingdom of saudi...
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Page 1 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
سم التمريضق
Internship Program
Clinical Skills Achievement Logbook
Name of Intern: ___________________________
Graduation Year: ___________________________
Page 2 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Contents Introduction ......................................................................................................................... 3
Internship Program Goals ................................................................................................... 3 Internship Program Objectives ........................................................................................... 3 Purpose of the Logbook ...................................................................................................... 3
Clinical Checklist Category: Medical Unit Rotation .......................................................... 4 Clinical Checklist Category: Dialysis Unit Rotation .......................................................... 7 Clinical Checklist Category: Surgical Unit Rotation .......................................................... 8
Clinical Checklist Category: Operating Room Rotation .................................................. 11 Clinical Checklist Category: Maternal and Obstetrics Unit Rotation ............................... 13
Clinical Checklist Category: Gynecology Unit Rotation.................................................. 15
Clinical Checklist Category: Labour and Delivery Room Rotation – Part 1 .................... 17
Clinical Checklist Category: Labour and Delivery Room Rotation – Part 2 .................... 20 Clinical Checklist Category: Pediatric Medical Unit Rotation ......................................... 22
Clinical Checklist Category: Pediatric Surgical Unit Rotation......................................... 26 Clinical Checklist Category: Neonatal/Pediatric Intensive Care Unit Rotation ............... 29 Clinical Checklist Category: Public Health Clinic Rotation............................................. 33
Clinical Checklist Category: Emergency Room Rotation ................................................ 34 Clinical Checklist Category: Intensive Care Unit Rotation .............................................. 37
Page 3 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
ـــلـــيـــموزارة الــتــع
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Introduction The internship program (also called internship year) consists of 48 weeks of clinical
training. It starts after the student's completion of his/her academic courses.
Internship program is considered as a complementary part of student's academic
program at the College of Applied Medical Sciences. The student shall not be eligible
to practice the profession until he/she completes the internship year.
Interns are assigned to different clinical units after the completion of the 4-year
nursing program.
The logbook includes a list of major clinical skills to ensure their achievement at each
specific training unit. It is designed to provide a guideline for nurse students during
the internship program.
The logbook is kept with the intern.
After completion of task, it is the responsibility of the intern to check and to
take the signature from immediate staff nurse trainer.
Upon the completion of the internship: The logbook should be submitted to the
Nursing Department at College of Applied Medical Sciences.
Internship Program Goals 1. To provide nursing students with an opportunity to strengthen nursing skills, apply
their knowledge in various clinical practices and demonstrate competency in practical
skill and procedure.
2. To facilitate the transition to professional role.
3. To develop an attitude of nursing caring.
Internship Program Objectives Upon completion of internship program, the professional nurse intern will:
1. Be acquainted with hospital policies and procedures.
2. Apply theoretical knowledge into various clinical setting.
3. Enhance effective communication skill.
4. Improve the ability to act independently and implement appropriate nursing
intervention.
5. Utilize appropriate available resources in patient care.
6. Ensure safe environment for patients, families and health care personnel.
7. Provide organized and quality patient care.
Purpose of the Logbook To emphasize major clinical skills in each unit rotation.
To assist in the follow up / progress of nurse intern throughout internship program.
Page 4 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Medical Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Receiving and
endorsing of patients
(at end of shift)
2 Caring of patient
hygiene
3 Performing admission
procedures
4 Performing discharge
procedures
5 Measuring and
documentation of
vital signs
6 Performing physical
health assessment
7 Measuring and
recording weight and
height
8 Testing blood sugar
using glucometer
9 Medication - Performing
calculation of dosage
- Preparation and
administration of:
Oral Medication
- Preparation and
administration of:
Subcutaneous
Medication
Page 5 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Preparation and
administration of:
Intravenous
Medication
- Preparation and
administration of:
Intramuscular
Medication
10 Performing CPR 11 Following aseptic
techniques in each
procedure
12 Documentation - Reviewing physician
orders on a regular
basis
- Documenting
accurately on hospital
forms
13 Assisting with safe
preparation and post
procedure care for
the following
procedures (as
applicable):
X-ray procedure
CT Scan
Endoscope
Ultrasound
ESWL procedures
Nuclear medicine
Insertion/Removal
of central lines
Caring of central
lines
CVP monitoring
14 Administration of
nebulizer
Page 6 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
15 Administration of
chemotherapy
16 Administration of
thrombolytic therapy
17 Administration of anti-
hypertensive
18 Nursing care and
management of:
Unstable Angina and
Ischemic Heart Disease
19 Nursing care and
management of:
Diabetes / DKA
20 Nursing care and
management of:
Cerebral Vascular
Accident
21 Cardiac management - Cardiac monitoring - ECG recording/
interpretation
- Recognizing basic and
life threatening
dysrhythmias
- Recognizing and
interpreting of unstable/
deteriorating patients
signs and symptoms
- Recognizing and
interpreting of laboratory
findings
- Performing focused
assessment on presenting
complications
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 7 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Dialysis Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Machine priming 2 Preparing of patient
for hemodialysis
3 Performing pre- and
post- dialysis care of
vascular access
(AVF, SC catheter)
4 Performing
predialysis patient
assessment
5 Performing patient
monitoring during
dialysis
6 Assisting in
peritoneal dialysis
7 Caring and
maintaining of exit
sites for peritoneal
dialysis
8 Infection controlling 9 Patient teaching 10 Obtaining blood
sample
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 8 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Surgical Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Receiving and
endorsing of patients
(at end of shift)
2 Caring of patient
hygiene
3 Performing admission
procedures
4 Performing discharge
procedures
5 Measuring and
documentation of
vital signs
6 Performing physical
health assessment
7 Measuring and
recording weight,
height
8 Testing blood sugar
using glucometer
9 Medication - Performing
calculation of dosage
- Preparation and
administration of:
Oral Medication
- Preparation and
administration of:
Subcutaneous
Medication
Page 9 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Preparation and
administration of:
Intravenous
Medication
- Preparation and
administration of:
Intramuscular
Medication
10 Performing CPR 11 Following aseptic
techniques in each
procedure
12 Documentation - Reviewing physician
orders on a regular
basis
- Documenting
accurately on hospital
forms
13 Preoperative
Management
- Organizing a pre-
chest x-rays, ECG
- Preoperative forms
and preparations
- Deep breathing and
coughing exercises
- Leg exercises 14 Pre-procedural
preparations
- Colonoscopy - OGD - CT
15 Post-operative
Management
- Immediate post-
operative care
- Positioning - Ambulation
Page 10 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Neurovascular
observation
- Measuring intake and
output
16 Surgical Dressing - Setup/of surgical field - Assessing of wound - Wound irrigation - Changing dressing
aseptically
- Packing a wound - Removal of sutures - Removal of staples - Drain monitoring - Drain removal
17 Renal/Urologic
Management
- Inserting an
indwelling catheter
- Continuous caring of
an indwelling catheter
- Maintaining of
continuous bladder
irrigation
- Caring of
nephrostomy tube
18 Orthopedic and care
of tractions
- Maintaining and
caring of traction
- Caring of Plaster cast - Applying of bandages
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 11 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Operating Room Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Using electronic life
support equipment
2 Vital signs and
monitoring
3 Draping, scrubbing,
gloving and gowning
techniques
4 Hemodynamic
monitoring
5 Performing sponge,
sharp and instruments
counts
6 Maintaining sterile
aseptic technique
7 Receiving patient at
surgical unit
8 Positioning patients
for operative
procedures –standard
surgical
9 Providing psycho-
social support of
patients
10 Providing immediate
postoperative care
Page 12 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
11 Providing full PACU
report (including
consciousness,
breathing, blood
pressure,
oxygenation, motor
function, etc.)
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 13 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Maternal and Obstetrics Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
Antenatal care 1 Performing
abdominal palpation
(abdominal
maneuver)
2 Measuring and
recording fetal heart
rate using Pinard and
Doppler
3 Performing urine test 4 Administering of
oxytocin at delivery
for control of PPH
continuous infusion
5 Performing CTG
care: Applying CTG
machine
6 Monitoring
contraction and fetal
heart rate
7 Interpreting CTG
reading and reporting
abnormalities and
providing care as
indicated
8 Caring of high risk
patients
9 Elective LSCS
Preparing for CS
10 Providing pre and
post-operative care
11 Collecting cord blood
sample
Page 14 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
12 Observing vaginal
bleeding, and
changing of dressing
13 Caring of patients
with hyperemesis
gravidarum
14 Performing urine
dipstick for ketones
and proteins
15 Caring of patients
with diabetes in
pregnancy
16 Post-natal routine
care
- Monitoring vital signs - Checking uterus and
lochia
- Assessing lower legs - Providing breast care - Educating mothers on
breast care
17 Documentation of
nursing note
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 15 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Gynecology Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Care of gynecology
oncology patient
- Caring of patient
undergoing radiation
- Caring of patient
undergoing
chemotherapy
2 Pre–operative care - Performing pre-
operative shaving
- Inserting
catheterization
3 Post-operative
OB/Gynae care
- Changing dressing - Removing of vaginal
pack
- Removing of urinary
catheter
- Providing nursing
care for:
Dilatation and
Curettage
- Providing nursing
care for:
Vaginal/ Abdominal
Hysterectomy
- Providing nursing
care for:
Anterior / Posterior
Repair
Page 16 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Providing nursing
care for:
Tubal Ligation
(Abdominal and
Laparoscopic)
- Providing nursing
care for:
Fistula Repair
- Providing nursing
care for:
Bartholin's Cyst
- Providing nursing
care for:
Ovarian Cyst
- Providing nursing
care for:
Cervical Cerclage
- Providing nursing
care for:
Pelvic Inflammatory
Disease
- Providing nursing
care for:
Salpingectomy /
Oopherectomy
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 17 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
لـــيـــموزارة الــتــعـــ
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Labour and Delivery Room Rotation – Part 1
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Receiving and
endorsing of patients
(at end of shift)
2 Caring of patient
hygiene
3 Performing discharge
procedures
4 Performing physical
health assessment
5 Measuring and
recording weight and
height
6 Testing blood sugar
using glucometer
7 Medication - Performing
calculation of dosage
- Preparation and
administration of:
Oral Medication
- Preparation and
administration of:
Subcutaneous
Medication
- Preparation and
administration of:
Intravenous
Medication
- Preparation and
administration of:
Intramuscular
Medication
Page 18 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
8 Performing CPR 9 Following aseptic
techniques in each
procedure
10 Documentation - Reviewing physician
orders on a regular
basis
- Documenting
accurately on hospital
forms
11 Admission of patient
in labour
- Measuring and
recording of vital
signs
- Palpating the
abdomen
- Assessing
contractions
- Testing urine - Administering fleet
enema as indicated
- Establishing an IV/
collection of blood
works
12 Management of
patient in labour
- Applying CTG
machine
- Monitoring
contraction and fetal
heart rate
- Interpreting CTG
reading and reporting
abnormalities and
providing care as
indicated
Page 19 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Filling in Partogram - Administering
analgesia
- Administering
inhalational analgesia
- Administering
narcotics
- Preparing trolley for
delivery
- Preparing trolley for
suturing
- Performing vaginal
examination (under
supervision)
- Inserting urinary
catheter
- Assisting with normal
vaginal delivery
- Inspecting of the
placenta and collection
of cord blood
- Preparing patient for
emergency caesarian
section
13 Performance of
physical health
assessment and
nursing
management
- Pre-eclampsia - Hemorrhage (ante-
and post-partum)
- Fetal distress
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 20 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Labour and Delivery Room Rotation – Part 2
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Immediate newborn
care:
- Checking and
preparing newborn
resuscitation
- Suctioning of the
baby
- Providing eye care - Administering of
oxygen as indicated
- Participating in
advanced
resuscitation
- Assessing Apgar
score
2 Examining the
newborn
- Measuring the baby’s
head circumference
- Measuring the baby’s
weight
- Measuring the baby’s
height
- Inspecting umbilical
cord
- Applying
identification of
newborn
Page 21 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
3 Caring of Mother - Providing perineal –
Episiotomy care
- Checking uterus and
lochia
4 Documentation - Filling in the birth
register
- Filling in the
obstetrical booklet
- Filling in the proper
documentation
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 22 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Pediatric Medical Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Receiving and
endorsing of patients
(at end of shift)
2 Caring of patient
hygiene
3 Performing admission
procedures
4 Performing discharge
procedures
5 Measuring and
documentation of
vital signs
6 Testing blood sugar
using glucometer
7 Medication - Performing
calculation of dosage
- Preparation and
administration of:
Oral Medication
- Preparation and
administration of:
Subcutaneous
Medication
- Preparation and
administration of:
Intravenous
Medication
Page 23 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Preparation and
administration of:
Intramuscular
Medication
- Preparation and
administration of:
Intradermal
Medication
- Preparation and
administration of:
Eye Drops
- Preparation and
administration of:
Ear Drops
- Preparation and
administration of:
Nasal Drops
- Preparation and
administration of:
Eye Ointments
- Preparation and
administration of:
Enema
8 Performing CPR 9 Following aseptic
techniques in each
procedure
10 Documentation - Reviewing physician
orders on a regular
basis
- Documenting
accurately on hospital
forms
Page 24 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
11 Measuring and
recording of:
- Abdominal Girth - Weight - Length - Head circumference - Chest circumference - Arm circumference
12 Collecting
laboratory
specimens
- Urine - Stool - Blood - Nasal secretions - Sputum - Throat swabs
13 Performance of
physical health
assessment and
nursing
management
- Cardiovascular - Respiratory - Gastrointestinal - Musculoskeletal - Integumentary - Neurological - Metabolic - Hematology and
Oncology
- Endocrine - Genitourinary
Page 25 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
14 Patient safety - Using bedrails
appropriately
- Using restraints when
required
- Performing education
of mother
15 IV therapy - Care of IV Heplock/
cannula and cannula
flushing
16 Oxygen
administration/
respiratory therapy
- Using simple face
mask
- Using nasal cannula - Using tracheostomy
mask
- Using incentive
spirometry
- Using Ambu -
bagging (pediatric
and neonate
- Inserting oral airway
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 26 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
العربية السعوديةالمملكة
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Pediatric Surgical Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Receiving and
endorsing of patients
(at end of shift)
2 Caring of patient
hygiene
3 Performing admission
procedures
4 Performing discharge
procedures
5 Measuring and
documentation of
vital signs
6 Performing physical
health assessment
7 Measuring and
recording weight and
height
8 Testing blood sugar
using Glucometer
9 Medication - Performing
calculation of dosage
- Preparation and
administration of:
Oral Medication
- Preparation and
administration of:
Subcutaneous
Medication
Page 27 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Preparation and
administration of:
Intravenous
Medication
- Preparation and
administration of:
Intramuscular
Medication
10 Performing CPR 11 Following aseptic
techniques in each
procedure
12 Documentation - Reviewing physician
orders on a regular
basis
- Documenting
accurately on hospital
forms
13 Surgical nursing
care
- Pre-operative care - Post-operative care - Positioning - Transporting of child - Care of wound - Caring of drains - Removal of sutures,
staples
Page 28 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
ديةالمملكة العربية السعو
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
14 Performance of
physical health
assessment and
nursing
Management
- General surgery - Plastic surgery - Orthopedic - Renal - Neurological - Urinary surgery
15 Patient safety
- Using bedrails
appropriately
- Using restraints when
required
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 29 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Neonatal/Pediatric Intensive Care Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Receiving and
endorsing of patients
(at end of shift)
2 Caring of patient
hygiene
3 Performing admission
procedures
4 Performing discharge
procedures
5 Measuring and
documentation of
vital signs
6 Performing physical
health assessment
7 Measuring and
recording weight and
height
8 Testing blood sugar
using glucometer
9 Medication - Performing
calculation of dosage
- Preparation and
administration of:
Oral Medication
- Preparation and
administration of:
Subcutaneous
Medication
- Preparation and
administration of:
Intravenous
medication
Page 30 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
التطبيقية كلية العلوم الطبية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Preparation and
administration of:
Intramuscular
medication
10 Performing CPR 11 Following aseptic
techniques in each
procedure
12 Documentation - Reviewing physician
orders on a regular
basis
- Documenting
accurately on hospital
forms
13 Assessing newborn
reflexes
14 Measuring and
recording intake and
output
15 Feeding - Performing
nasogastric tube
feeding
- Performing
gastrostomy tube
feeding
- Performing
nasoduodenal tube
feeding
- Performing artificial
feeding for neonates
Page 31 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
16 Performance of
physical health
assessment and
nursing
management
- Premature neonate
and low birth infant
- Term neonate - Congenital anomalies
(cardiac, respirator,
gastric, neurological,
urinary tract and
hydrocephalus)
- Down syndrome - Communicable
disease
- Respiratory disease
and nephritic
syndrome
- Seizures,
unconscious,
comatose
- Diabetic - Post-natal disorder - Jaundice - Infant of diabetic
mother
- Respiratory surfactant
disorder
- Care with sepsis 17 Patient safety and
oxygenation
- Using incubator and
phototherapy
- Using restraints –
when required
- Using radiant warmer - Applying daily and
terminal care of
incubators
Page 32 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Providing incubator
oxygen therapy
- Performing postural
drainage
- Performing
tracheostomy
suctioning
- Performing oral
suctioning
- Performing nasal
suctioning
18 IV therapy - Caring of IV
(Heplock/cannula
dressing)
- Caring of IV
(Heplock/cannula
flushing)
- Blood transfusion
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 33 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
طبيقيةكلية العلوم الطبية الت
قسم التمريض
Clinical Checklist Category: Public Health Clinic Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Applying two nursing
processes for two
cases – mother with
her child
2 Working as care
provider in different
clinical areas
3 Implementing health
education about
chronic diseases
(such as diabetes,
hypertension)
4 Implementing health
education to women
regarding different
basic health concepts
and reproductive
health issues (such as
child care, breast
feeding, weaning,
immunization)
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 34 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Emergency Room Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Receiving and
endorsing of patients
(at end of shift)
2 Caring of patient
hygiene
3 Measuring and
documentation of
vital signs
4 Performing physical
health assessment
5 Measuring and
recording weight and
height
6 Testing blood sugar
using glucometer
7 Medication - Performing
calculation of dosage
- Preparation and
administration of:
Oral Medication
- Preparation and
administration of:
Subcutaneous
Medication
- Preparation and
administration of:
Intravenous
Medication
- Preparation and
administration of:
Intramuscular
Medication
Page 35 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
8 Performing CPR 9 Following aseptic
techniques in each
procedure
10 Documentation - Reviewing physician
orders on a regular
basis
- Documenting
accurately on hospital
forms
11 Defibrillation /
Cardioversion
12 Administration of
thrombolytic therapy
13 Administration of
vasopressin
14 Performance of
physical health
assessment –
- Adult/Pediatric/
Neonate
- A,B,C,D,E for trauma
patient
15 Triage system - Demonstrating
criteria for
prioritizing patient
management
- Demonstrating
awareness of hospital
fire and disaster
protocol
16 Admissions
procedure
- ICU - In–patient - Direct to OR - Labor and delivery
Page 36 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
17 Medicolegal cases - Aware of clinical
situations which should
be reported to the
police
18 Respiratory/oxygen
therapy
- Applying care for
airway
- Ambu – bagging - Inserting oral airway
19 Mother in labor - Assessing of
contraction
- Assessing of F.H.R. - Performing obstetric
examination
20 Multi-trauma patient - Caring of patient with
suspected cervical
fracture
- Stabilizing fractures
with splints
- Caring of head injury
patient
21 Burn patient - Fluid resuscitation - Dressings
22 Performing discharge
procedures
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date:
Page 37 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
Clinical Checklist Category: Intensive Care Unit Rotation
Started From: ______/____/______ To _____/_____/_____
For each skill demonstrated by the intern, the preceptor/staff nurse trainer will sign in the
appropriate column. The nurse intern is able to discuss the policy and demonstrate the
following skills.
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
1 Receiving and
endorsing of patients
(at end of shift)
2 Caring of patient
hygiene
3 Performing admission
procedures
4 Performing discharge
procedures
5 Measuring and
documentation of
vital signs
6 Performing physical
health assessment
7 Measuring and
recording weight and
height
8 Testing blood sugar
using glucometer
9 Medication - Performing
calculation of dosage
- Preparation and
administration of:
Oral Medication
- Preparation and
administration of:
Subcutaneous
Medication
Page 38 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Preparation and
administration of:
Intravenous
Medication
- Preparation and
administration of:
Intramuscular
Medication
10 Performing CPR 11 Following aseptic
techniques in each
procedure
12 Documentation - Reviewing physician
orders on a regular
basis
- Documenting
accurately on hospital
forms
13 Basic unit skills
- Defibrillation
/cardioversion
- Administration of
thrombolytic therapy
- Caring of temporary
pacemaker
transcutaneous
/transvenous
14 Airway and
ventilation
management
- Caring of mechanical
ventilator
- Assisting in initiating
invasive and
noninvasive
mechanical ventilator
- Providing care for
patient with
mechanical ventilator
Page 39 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Assisting in weaning
from mechanical
ventilator
- Assisting in insertion
of airway tube
(endotracheal ,
tracheostomy,
nasopharyngeal )
- Providing care of
airway tube
- Suctioning of airway
passage
15 Central lines - Collecting of
equipment for
insertion of central
line
- Discussing the
normal parameters for
CVP measurement
- Determining and
records CVP using a
water
- Identifying chest
landmarks for CVP
measurement
- Flushing of a central
line
- Administering of
drugs and fluids
- Assisting in
aseptically changing
central IV lines
- Aseptically changing
central IV lines
dressing
- Setting up a
transducer systems
Page 40 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
16 Pulmonary artery
catheters and
arterial lines
- Taking appropriate
action to prevent or
resolves
complications of PA
catheters and arterial
lines
- Sitting up a single
and multiple
transducer system
- Identifying a PA and
arterial trace on the
cardiac monitor
- preforming zeroing of
PA and arterial lines
- Preforming Allen's
test
17 Feeding
management
- Administering of
TPN
- Administering tube
feeding through
Tummy syringe
- Using feeding pump 18 Underwater seal - Assisting in
insertion/removal of
underwater seal
drainage
- Caring of underwater
seal drainage
19 Nursing care of
specific patients
- Post-operative
bleeding
Page 41 of 41
Kingdom of Saudi Arabia Ministry of Education
Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences
Nursing Department
المملكة العربية السعودية
وزارة الــتــعـــلـــيـــم
جامعة األمير سطام بن عبد العزيز
كلية العلوم الطبية التطبيقية
قسم التمريض
# List of Essential Skills Observed
(add Date of Achievement) Mastered
(add Date of Achievement) Remarks 1st 2nd 3rd 1st 2nd 3rd
- Unconscious (general
care to prevent of foot
drop and
contractures)
- Post PTCA - Post cardiac
catheterization
- Intracranial surgeries - Fractures and
osteoarthritis
- Biliary and pancreatic
disorder
- MI/unstable angina - Intestinal obstruction,
colonic surgery and
ostomies
- Intracranial surgeries - Fractures and
osteoarthritis
Head Nurse / Clinical Instructor Hospital Training Coordinator
Name: Name:
Signature and Date: Signature and Date: