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BAG TECHNIQUE PROCEDUREFORMAT
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 BEASSESSED BASED ON THEFAMILYREQUIREMENTS:
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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:
1.---------------------------------------------------------------------------------------------------------------------------
2. ---------------------------------------------------------------------------------------------------------------------------
3…………………………………………………………………………………………………….............
4…………………………………………………………………………………………………….............
5………………………………………………………………………………………………………….....
6…………………………………………………………………………………………………………….
7…………………………………………………………………………………………………………......
8…………………………………………………………………………………………………………….
9…………………………………………………………………………………………………………….
10……………………………………………………………………………………………………………
PREPARATION OF THEPERSON AND ARTICLES IN PROCEDURE AREA:
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HOWTO PERFORMED THE PROCEDURE:
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AFTER CARE OF THE PROCEDURE:
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HEALTH EDUCATIONRELATED 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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CHECKLIST FOR BAG TECHNIQUE PROCEDURE:
S.NO: SKILLS PERFORMEDBYTHE
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 ofselection 1
5. Selection ofprocedure based on
standing order
1
6. Type person selected for procedure 1
7. Explain the procedure to the person 1
8. Spreading and selection ofplace for
keeping bag
1
9. Way of opening the bag technique 1
10. Hand washing articles taken from bag 1
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 ofthe procedure
1
17. Discard the waste 1
18. Frequent hand washing 1
19. Replacement ofarticles to the
compartment ofbag
1
20. Folding of newspaper/washing the
hands/replacement ofarticles
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 ofthe supervisor with date:
Signature ofthe HODS with date:

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Bag technique procedure format ii

  • 1. BAG TECHNIQUE PROCEDUREFORMAT 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 BEASSESSED BASED ON THEFAMILYREQUIREMENTS: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- GOAL AND OBJECTIVES OF THE PROCEDURE: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------
  • 2. ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- PURPOSE OF THE PROCEDURE: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- PRINCIPLES TO BE FOLLOWED WHILE CARING PROCEDURE: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- LIST OF ARTICLES TO BE REQUIRED WITH RATIONALE: 1.--------------------------------------------------------------------------------------------------------------------------- 2. --------------------------------------------------------------------------------------------------------------------------- 3……………………………………………………………………………………………………............. 4……………………………………………………………………………………………………............. 5…………………………………………………………………………………………………………..... 6……………………………………………………………………………………………………………. 7…………………………………………………………………………………………………………...... 8……………………………………………………………………………………………………………. 9……………………………………………………………………………………………………………. 10…………………………………………………………………………………………………………… PREPARATION OF THEPERSON AND ARTICLES IN PROCEDURE AREA:
  • 3. ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- HOWTO PERFORMED THE PROCEDURE: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- AFTER CARE OF THE PROCEDURE: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- HEALTH EDUCATIONRELATED TO PROCEDURE:
  • 4. ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- RECORDING AND REPORTING OF PROCEDURE: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- SUMMARY: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ CONCLUSION: ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- CHECKLIST FOR BAG TECHNIQUE PROCEDURE: S.NO: SKILLS PERFORMEDBYTHE STUDENTS MARKS ALLOTTED MARKS OBTAINED REMARKS
  • 5. 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 ofselection 1 5. Selection ofprocedure based on standing order 1 6. Type person selected for procedure 1 7. Explain the procedure to the person 1 8. Spreading and selection ofplace for keeping bag 1 9. Way of opening the bag technique 1 10. Hand washing articles taken from bag 1 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 ofthe procedure 1 17. Discard the waste 1 18. Frequent hand washing 1 19. Replacement ofarticles to the compartment ofbag 1 20. Folding of newspaper/washing the hands/replacement ofarticles 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 ofthe supervisor with date: Signature ofthe HODS with date: