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UNIVERSITY OF LA SALETTE COLLEGE OF NURSING Santiago City, Isabela SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-PARTAL CARE COMPETENCY

In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009 Signature over Printed Name of Student: ___________________________________________ INTRAPARTAL COMPETENCIES I. SAFE AND QUALITY NURSING CARE (SQC) 1. Obtains obstetrical history including parity, gravida score, LMP, EDC, AOG, BOW onset of true labor. 2. Checks vital signs. 3. Conducts physical examination. 4. Performs Leopold’s maneuver. 5. Checks Fetal Heart Rate and Fundic height. 6. Monitor progress of labor/ uterine contractions as to: • Frequency • Duration • Intensity • Interval 7. Observes for the timely rupture of membrane. 8. Coaches mother on process of labor. PERFORMS FUNCTIONS DURING ACTUAL LABOR 1. Transports clients safely while providing privacy. 2. Places mother in lithotomy position. 3. Performs perineal care using sterile technique correctly. 4. Performs proper hand scrub. 5. Wears gown and gloves according to hospital policy. 6. Performs Ritgen’s maneuver safely. 7. Coaches mother on breathing and pushing techniques. 8. Delivers baby and placenta carefully. • Checks and manages cord recoil correctly • Clamps and cuts the cord correctly • Identify signs of placental separation • Checks the characteristic/ completeness of the placenta 9. Assesses amount of blood loss (Normal: <500 cc) 10. Employs interventions to achieve and maintain a well contracted uterus to prevent/control hemorrhage. • Uterine massage • Correct administration of oxytocin • Cold compress 11. Assesses presence and degree of laceration. 12. Assists in episiorrhaphy. 13. Checks size, consistency and location of uterus. 14. Performs perineal care and applies pad correctly. 15. Provides emotional support to the mother throughout labor and delivery. 16. Evaluates patient’s condition and records pertinent data accordingly. 17. Prepares patient for transfer to recovery room/ ward. DESIRED 1st 2nd 3rd AVERAGE RATING RLE RLE RLE RATING 4 1 2 2 2 1 1 1 1 1 2 1 1 1 1 1 2 1 1 1 1 1

2 1 1 1

1 1 1 1 1 2 1

ENVIRONMENT AND EQUIPMENT (MRE) .II. MANAGEMENT OF RESOURCES.

Identifies researchable problems related to labor and delivery. cultural and ethnic practices of the family of the woman in labor and delivery. 1 3. 1 3. bulb syringe. suture. Documents all pertinent data correctly and completely.) 5. 1 3. Ensures privacy and confidentiality. Secures informed consent in all procedures related to labor and 1 delivery. Promotes emotional security by supporting needs. gauze. LEGAL RESPONSIBILITIES (LR) 1. instruments and equipment needed. Documents accurately relevant data about client. 2 4. Demonstrates proper “latch-on” breast feeding technique (done 1 post-partum period). 2. 1 3. needle holder. Recommends corrective and preventive measures for the 1 identified deviations. Utilize findings of research studies in intra-partal care. time of delivery of 2 the baby and placenta. 2. VIII. Observes precautionary measures related to use of electrical 1 equipment. scissors. Uses supplies diligently. ETHICO-MORAL RESPONSIBILITIES (EMR) 1 1. 1 V. RECORDS MANAGEMENT (RM) 1. 1 VI. 1 4. Maintains adequacy of supplies as the delivery progresses. Teaches client on basic preparation during labor and deliver (can be done in the labor room) 2. Provides discharge instructions as to feeding. Participates in audit practices in the delivery room/lying in. catheter (optional)] 1 • Kelly pad 1 • Disinfectant 2. 1 • Sterile drape 1 • Sterile instruments and equipment [Forceps. III.) 6. Performs functions according to standards. appointment dates for post natal and well baby check up (done post-partum period. 1 administration of ordered medications. Coaches’ client on breathing/ bearing down technique. HEALTH EDUCATION (HE) 1 1. 1 4. 6.1. 1 4. Respects the religious. Ensures a quiet environment. Performs after care of the materials and equipments used. 1 VII. 1 5. Gives instructions to parents regarding infant care before discharge (done post-partum period. 1 7. Performs sterilization procedure. RESEARCH (R) (preferably done during post conferences) 1. Ensures proper disposal of hospital waste including blood and 1 other fluids. Projects a professional image of a delivery room nurse. Reports accurately and honestly the gender. Responds to questions of clients and relatives regarding 1 expectations. 2 IX. Updates oneself with the latest trends and development in labor 1 and delivery. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. bathing. Ensures proper identification of the mother and newborn. Identifies deviation of practice from the standards. 1 8. 3. Maintains orderliness of the sterile table. 1 2. IV. Prepares room. 2 2. 1 . QUALITY IMPROVEMENT (QI) (preferably done during post conferences) 1. 1 9. 2 3. Accepts criticisms and recommendations. 2.

Establishes collaborative relationship with members of the health team and family members.___ Summer____ Signature________________________ Validity: ________________________ Verified True and Correct: ________________________________ (Signature Over Printed Name) Clinical Coordinator License Number _________________ Validity ________________________ Academic Year Graduated: ________________________________ ______________________________________ DEAN Signature Over Printed Name License Number ___________________ Validity Date _____________________ UNIVERSITY OF LA SALETTE COLLEGE OF NURSING .___ 2nd Sem. Functions effectively as a team player in the delivery room/lying in. XI.___ 2nd Sem. 2. 3.___ Summer____ Signature________________________ Validity: ________________________ 1st Sem. Maintains an organized system of filing and keeping records of the client. TOTAL SCORE: 1 1 1 1 1 1 1 90 First Graded RLE Clinical Instructor Second Graded RLE Clinical Instructor Third Graded RLE Clinical Instructor : Academic Year____________ : Name____________________ License Number: __________ : Academic Year____________ : Name____________________ License Number: __________ : Academic Year____________ : Name____________________ License Number: __________ 1st Sem.___ Summer____ Signature________________________ Validity: ________________________ 1st Sem. Utilizes appropriately all forms of communication. Communicates the progress of labor/delivery to significant others. nonverbal. 3. COMMUNICATION (Comm) 1. X. Listens attentively to clients and families queries and requests. Inform client’s significant others of the progress of labor and delivery. electronic. 2. verbal.2. COLLABORATION AND TEAMWORK (CTW) 1.___ 2nd Sem.

3. head. Gives oil/ water and soap bath according to institutional 1 policy. Applies CREDE’s prophylaxis on the eyes. 01 Series 2009 Signature over Printed Name of Student: ___________________________________________ NEWBORN COMPETENCIES DESIRED 1st 2nd 3rd AVERAGE RATING RLE RLE RLE RATING I. Reports any signs of deviation/abnormality to the 1 pediatrician. cord clamp. cotton balls. Administers Vitamin K (1 mg/M) into the lateral 1 anterior thigh or vastus lateralis. 1 . II. 8. abdominal circumference. Ensures proper identification of newborn (name tag: name 2 of mother. Latches newborn to the mother’s breast immediately 1 after birth. 3 2. Performs physical assessment including anthropometric 4 measurements including weight. 11. 1 • Disinfects area properly according to hospital policy 1 • Clamps and cuts cord 1 inch from the abdomen 1 • Checks for the presence of 2 arteries and 1 vein 1 • Dresses cord aseptically according hospital policy 13. Keeps baby wrapped warmly under floor lamp or 1 beside mother according to institutional policy until discharge. Vitamin K. gender and name of attending physician). 7.Santiago City. 15. Prepares instrument and equipment needed 4 • Suction bulb. Establishes and maintains patent airway. 2. Maintain adequacy of supplies as newborn care is rendered 1 4. droplight. SAFE AND QUALITY NURSING CARE (SQC) 1. 1 • Places under droplight as needed 5. ENVIRONMENT AND EQUIPMENT (MRE) 1. Performs and interprets APGAR scoring correctly. Performs cord dressing aseptically. 1 12. Maintains orderliness of the working area. Records pertinent observations and nursing care done. 10. Dries newborn and wraps warmly. gauze. 14. Puts the newborn in Trendelenburg position. 2 2 • Immediately after delivery • After 5 minutes 6. date and time of delivery. antimicrobial ophthalmic ointment. height. MANAGEMENT OF RESOURCES. Takes vital signs (temperature per rectum to check 1 patency) 9. 2 4. blanket. 1 3. Suctions mouth and nose of the newborn gently. 1 16. chest. Ensures use of sterile equipment during immediate care of 1 the newborn. disinfectant. Isabela SUMMARY PERFORMANCE EVALUATION ACHIEVING IMMEDIATE CARE OF THE NEWBORN COMPETENCY In Accordance with PRC Board of Nursing Memorandum No.

5. Observes precautionary measures related to use of electrical equipment. 1 .

1 3. 1 3. 1 non-verbal. 4. Documents all pertinent data correctly and completely. Performs foot printing according to hospital policy. 1 8. XI. 1 X. Projects a professional image of the pediatric nurse. 2. Communicates findings of assessment to all concerned. VI. VIII. Ensures a warm and quiet environment. Identifies researchable problems related to immediate care of 2 newborn. Identifies deviation of practice from the standards. Updates oneself with the latest trends and developments in 1 newborn care. Utilizes findings of research studies in the immediate care of 2 the newborn. Provides discharge instructions to the mother on when to 2 expect cord to fall off or to report signs of cord infection. 1 4. etc. 3. LEGAL RESPONSIBILITIES (LR) 1. 1 4. Utilizes appropriately all forms of communication. verbal. COLLABORATION AND TEAMWORK (CTW) 1. feeding. 4. Maintains an organized system of filing and record keeping. 2. Uses supplies diligently. Reports accurately any deviations/abnormal findings and 1 nursing interventions rendered. Recommends corrective and preventive measures for the 1 identified deviations. electronic. 2. RESEARCH (R) (preferably done during post conferences) 1. 2 immunization. 1 VII. 1 2.6. 1 2. 1 V. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Listens attentively to queries and requests of mothers and 1 family members. QUALITY IMPROVEMENT (QI) (preferably done during post conferences) 1. IX. 2. Informs mother of relevant information about the newborn. 1 III. Accepts criticisms and recommendations. IV. HEALTH EDUCATION (HE) 1. 5. Identifies newborn by comparing ID band with data in the 2 chart. Ensures that birth certificate and other civil registration forms 2 are accomplished/ filled out according to institutional policy. Respects the religious. 2. 2. cultural and ethnic practices of the 1 family of the newborn. Documents accurately relevant data about the newborn. 3. Functions effectively as a team player in the nursery. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. COMMUNICATION (Comm) 1. Maintains privacy and confidentiality of findings of 1 assessments. Responds to questions of mother and relatives regarding 1 expectations. 1 7. Provides instructions to the mother on daily cord care and 2 prevention of cord infection. 1 3. Participates in audit practices in the delivery room/lying in. RECORDS MANAGEMENT (RM) 1. 2. Ensures proper disposal of hospital waste. 1 1 . Maintains an open line of communication with the mother and 1 other family members. Performs functions according to standards. Provides information regarding newborn screening.

Isabela . TOTAL SCORE: 1 75 First Graded RLE Clinical Instructor Second Graded RLE Clinical Instructor Third Graded RLE Clinical Instructor : Academic Year____________ : Name____________________ License Number: __________ : Academic Year____________ : Name____________________ License Number: __________ : Academic Year____________ : Name____________________ License Number: __________ 1st Sem.3.___ Summer____ Signature________________________ Validity: ________________________ 1st Sem. Establishes a collaborative relationship with members of the health team and family of the newborn.___ Summer____ Signature________________________ Validity: ________________________ 1st Sem.___ 2nd Sem.___ 2nd Sem.___ 2nd Sem.___ Summer____ Signature________________________ Validity: ________________________ Verified True and Correct: ________________________________ (Signature Over Printed Name) Clinical Coordinator License Number _________________ Validity ________________________ Academic Year Graduated: ________________________________ ______________________________________ DEAN Signature Over Printed Name License Number ___________________ Validity Date _____________________ UNIVERSITY OF LA SALETTE COLLEGE OF NURSING Santiago City.

Monitors client’s responses to surgery 2 2. sponges. SAFE AND QUALITY NURSING CARE (SQC) 1. Prepares surgical instruments. HEALTH EDUCATION (HE) 1. Receives client for surgery / endorses client post – 2 operatively d. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. Accepts responsibility and accountability for own 2 decisions and actions as an OR nurse VI. Assists in skin preparation and draping of client 2 5. Performs OR functions according to professional standards 4 . Adheres to legal and institutional protocols regarding 2 informed consent V. Promotes safety and comfort of patients inside the OR 2 3. Provides needed nursing interventions based on 4 identified needs d. MANAGEMENT OF RESOURCES. sutures and 2 other supplies in functional arrangement d. LEGAL RESPONSIBILITIES (LR) 1. Respects the rights of the OR client 2 2. 01 Series 2009 Signature over Printed Name of Student: ___________________________________________ INTRA-OPERATIVE CARE COMPETENCIES DESIRED 1st 2nd 3rd AVERAGE RATING RLE RLE RLE RATING I. Organizes work load to facilitate timely patient Care 4 2. Implements appropriate health education activities to client 2 based on needs assessment IV.SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-OPERATIVE CARE COMPETENCY In Accordance with PRC Board of Nursing Memorandum No. Performs the functions of the scrub nurse 4 a. Performs the functions of the circulating nurse 2 a. Utilizes the nursing process in the care of OR client 4 a. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Administers medications and other health therapeutics 2 safely II. Wears sterile gowns and gloves aseptically 2 c. Sets up the OR room and needed equipment 2 c. Identifies priority needs of the client at the Operating 4 Room c. Performs surgical count accurately 2 4. sponges. ENVIRONMENT AND EQUIPMENT (MRE) 1. Performs surgical scrub correctly b. Anticipates the needs of the surgical team b. Obtains comprehensive client’s information by checking complete accomplishment of the preoperative checklist/client’s chart b. Hands instruments. Maintains a safe environment at the OR by observing the 2 principles of asepsis III. sutures and other needed 2 materials according to surgeon’s preference e. Ensures functionality of OR resources 2 4. Utilizes adequate and appropriate resources to support the 2 OR team 3.

___ 2nd Sem. RESEARCH (R) (preferably done during post conferences) 1. Identifies and reports variances in sterility and other OR 2 activities VIII. Possesses positive attitude towards learning surgical and 2 OR-related knowledge and skills VII.2. COMMUNICATION (Comm) 1. COLLABORATION AND TEAMWORK (CTW) 1. Disseminates results of OR-related research findings to 2 clinical group and other members of the OR team as appropriate IX. Establishes rapport with patients. significant others and 1 members of the health team 2.___ 2nd Sem. Participates in quality improvement activities related to 2 infection control and successful OR operations 2.___ 2nd Sem. Uses appropriate information mechanisms to facilitate 2 communication inside the OR and with other departments in the hospital XI.___ Summer____ Signature________________________ Validity: ________________________ 1st Sem.___ Summer____ Signature________________________ Validity: ________________________ 1st Sem. Maintain accurate and updated documentation of patient 2 care X. QUALITY IMPROVEMENT (QI) (preferably done during post conferences) 1.___ Summer____ Signature________________________ Validity: ________________________ Verified True and Correct: ________________________________ (Signature Over Printed Name) Clinical Coordinator License Number _________________ Validity ________________________ Academic Year Graduated: ________________________________ ______________________________________ DEAN Signature Over Printed Name License Number ___________________ Validity Date _____________________ . RECORDS MANAGEMENT (RM) 1. Collaborates plan of care with other members of the health 2 team TOTAL SCORE: 75 First Graded RLE Clinical Instructor Second Graded RLE Clinical Instructor Third Graded RLE Clinical Instructor : Academic Year____________ : Name____________________ License Number: __________ : Academic Year____________ : Name____________________ License Number: __________ : Academic Year____________ : Name____________________ License Number: __________ 1st Sem.