Student Observer RecordCOLON HYDROTHERAPYSUPERVISED PRACTICE TREATMENT SESSION Student Name * First Name Last Name Date MM DD YYYY Training School Observer Clients Name First Name Last Name Pre-Treatment Procedures Did the student set up the room with their equipment prior to client arriving? Yes No Did the student welcome the client, introduce themselves and explain the treatment procedure? Yes No Did the student ask the client to complete the RICTAT client confidential questionnaire and consent form? Yes No Did the student review the clients form and check the client has no contraindications or any changes to their medical history? Yes No Did the student offer the client a robe/gown to change into and to use the toilet before the commencement of the treatment? Yes No Did the student make sure that the disposable equipment was to hand? Yes No Did the student make sure that couch was prepared and ready for the client? Yes No Overall Rating 1 - Poor 2 - Fair 3 - Satisfactory 4 - Good 5 - Excellent Comments Treatment Procedures Did the student raise the height of the bed? (If applicable) Yes No Did the student put on disposable gloves? Yes No Did the student ask the client to lie on their left-hand side and draw their knees up and explain why? Yes No Did the student lubricate the speculum? Yes No Did the student advise the client that they were going to insert the speculum and get consent from them to begin the treatment? Yes No Did the student reassure the client during the insert of the speculum and connection of the waste/water lines and explain what was happening? Yes No Did the student take a note of the time or start a timer before commencing treatment? Yes No Did the student start the flow of water gently whilst watching the pressure and temperature gauges and respond accordingly to the client’s feedback? Yes No Did the student allow the client to go to the toilet during the treatment, if required? Yes No Did the student explain to the client when releasing water what they can see? And what they are looking for? Yes No Did the student answer questions from the client? Yes No Did the student reassure the client throughout that the treatment is client led? Yes No Did the student massage the client’s abdominal area as appropriate and seek consent to do this? Yes No During the treatment did the student observe the privacy and dignity of the client? Yes No Did the student advise the client that the treatment time was nearing the end? Yes No Overall Rating 1 - Poor 2 - Fair 3 - Satisfactory 4 - Good 5 - Excellent Comments End of Treatment Procedure Did the student ask the client to turn on to their left-hand side whilst they removed the speculum? Yes No Did the student drain any residual water out of the tubes and turn off the equipment? Yes No Did the client advise the client to sit up carefully and if necessary, of the edge of the couch for a few moments before inviting them to go to the toilet? Yes No Did the student dispose of all treatment consumables appropriately? Yes No Did the student wipe down all surfaces in treatment room and toilet and wash their hands? Yes No Did the student provide the client with any post-treatment advice or guidance before they left? Yes No Did the student clean the toilet area once the client had left? Yes No Did the student accurately record the treatment on the RICTAT treatment observation form? Yes No Overall Rating 1 - Poor 2 - Fair 3 - Satisfactory 4 - Good 5 - Excellent Comments Action Plan Student Feedback Signed - Student Date MM DD YYYY Signed - Observer Date MM DD YYYY Verifier Date MM DD YYYY Thank you!
