BAG TECHNIQUE PROCEDURE FORMAT -EVALUATION II.docx

The bag technique is a procedure used by community health nurses for home visits to efficiently and safely provide nursing care by creating a clean work area. The process involves arriving at the client's home, setting up a clean workspace with a paper/plastic lining, performing handwashing and putting on an apron, laying out only necessary supplies, providing care, cleaning all equipment, and then properly packing the bag for the next visit. Proper hand hygiene is crucial at every step to prevent the spread of infection

1. BAG TECHNIQUE PROCEDURE FORMAT
IDENTIFICATION OF THE PERSON:
Name of the person:……………………………………………………………………………………….
Age /sex of the person:……………………………………………………………………………………
Education of the person:………………………………………………………………………………….
Occupation of the person:………………………………………………………………………………..
Address of the person:……………………………………………………………………………………...
………………………………………………………………………………………
……………………………………………………………………………………..
Complaints of :……………………………………………………………………………………………...
Community diagnosis:……………………………………………………………………………………..
Name of the procedure:…………………………………………………………………………………….
Date of the procedure:……………………………………………………………………………………..
Time of the procedure:…………………………………………………………………………………….
Procedure performed by:………………………………………………………………………………….
Procedure supervised by :………………………………………………………………………………….
Requirements of the procedure:…………………………………………………………………………..
NEEDS AND PROBLEM TO BE ASSESSED BASED ON THE FAMILY REQUIREMENTS:
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GOAL AND OBJECTIVES OF THE PROCEDURE:
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PURPOSE OF THE PROCEDURE:
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PRINCIPLES TO BE FOLLOWED WHILE CARING PROCEDURE:
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LIST OF ARTICLES TO BE REQUIRED WITH RATIONALE:
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2. ---------------------------------------------------------------------------------------------------------------------------
3…………………………………………………………………………………………………….............
4…………………………………………………………………………………………………….............
5………………………………………………………………………………………………………….....
6…………………………………………………………………………………………………………….
7…………………………………………………………………………………………………………......
8…………………………………………………………………………………………………………….
9…………………………………………………………………………………………………………….
10……………………………………………………………………………………………………………

3. PREPARATION OF THE PERSON AND ARTICLES IN PROCEDURE AREA:
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HOW TO PERFORMED THE PROCEDURE:
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AFTER CARE OF THE PROCEDURE:
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4. -------------------------------------------------------------------------------------------------------------------------------
HEALTH EDUCATION RELATED TO PROCEDURE:
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RECORDING AND REPORTING OF PROCEDURE:
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SUMMARY :
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CONCLUSION:
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5. CHECKLIST FOR BAG TECHNIQUE PROCEDURE:
S.NO:SKILLS PERFORMED BY THE
STUDENTS
YES NO REMARKS
1. Adequate supplies and equipment
2. Nursing diagnosis assessment
3. Need to be assessed based on family
requirement
4. Appropriate to goal/purpose of selection
5. Selection of procedure based on standing
order
6. Type person selected for procedure
7. Explain the procedure to the person
8. Spreading and selection of place for
keeping bag
9. Way of opening the bag technique
10. Hand washing articles taken from bag
11. Perform the hand washing in the
community area
12. Articles arranged for the procedure with
rationale
13. Maintain comfortable during the
procedure for the person as well as
her/him
14. Maintain good communication skills and
used scientific knowledge
15. Performing allotted procedure
16. Assessed the accurate recording /finding
of the procedure
17. Discard the waste
18. Frequent hand washing
19. Replacement of articles to the
compartment of bag
20. Folding of newspaper/washing the
hands/replacement of articles
21. Health education appropriate to the
procedure
22. Summating the procedure
23. Conclude the procedure
24. Recording the procedure
25. Plan for the next visit
Total:
Signature of the student with date: Signature of the supervisor with date:

Signature of the HODS with date:

6. EVALUATION FORMAT FOR BAG TECHNIQUE
S.NO:SKILLS PERFORMED BY THE
STUDENTS
MARKS
ALLOTTED
MARKS
OBTAINED
REMARKS
1. Adequate supplies and equipment 1
2. Nursing diagnosis assessment 1
3. Need to be assessed based on family
requirement
1
4. Appropriate to goal/purpose of selection1
5. Selection of procedure based on standing
order
1
6. Type person selected for procedure1
7. Explain the procedure to the person1
8. Spreading and selection of place for
keeping bag
1
9. Way of opening the bag technique 1
10. Hand washing articles taken from bag1
11. Perform the hand washing in the
community area
1
12. Articles arranged for the procedure with
rationale
1
13. Maintain comfortable during the
procedure for the person as well as
her/him
1
14. Maintain good communication skills and
used scientific knowledge
1
15. Performing allotted procedure 1
16. Assessed the accurate recording /finding
of the procedure
1
17. Discard the waste 1
18. Frequent hand washing 1
19. Replacement of articles to the
compartment of bag
1
20. Folding of newspaper/washing the
hands/replacement of articles
1
21. Health education appropriate to the
procedure
1
22. Summating the procedure 1
23. Conclude the procedure 1
24. Recording the procedure 1
25. Plan for the next visit 1
Total: 25
Signature of the student with date: Signature of the supervisor with date:

Signature of the HODS with date: