Eastern Samar State University

College of Nursing
Borongan City

PERFORMANCE EVALUATION CHECKLIST

NEWBORN COMPETENCY

Name of Student: Michael Tangog Flores

Year/Clinical Group: 3rd year & 4th year
School Year: 2008-2009, 2009-2010
Inclusive dates of Clinical Rotation: July 2008-May 2009, July 2009-February 2010

NEWBORN COMPETENCIES WEIGHT SCORE REMARKS

I. SAFE AND QUALITY NURSING CARE
1. Establishes and maintains patent airway. 3
2. Puts newborn in Trendelenburg position. 1
3. Suctions mouth and nose of the newborn gently. 2
4. Dries newborn and wraps warmly. 1
 Places under droplight as needed.
5. Performs and interprets APGAR scoring correctly.
 Immediately after delivery 2
 After 5 minutes 2
6. Ensures proper identification of newborn (name tag: 2
name of mother, date and time of delivery, gender
and name of attending physician).
7. Performs physical assessment. 2
8. Takes anthropometric measurements including 2
weight, height, head, chest, abdominal
circumference.
9. Takes vital signs (temperature per rectum to check 1
patency)
10. Gives oil/water and soap bath according to 1
institutional policy.
11. Latches newborn to the mother’s breast 1
immediately after birth.
12. Applies CREDE’s prophylaxis on the eyes. 1
13. Performs cord dressing aseptically.
 Disinfects area properly according to hospital 1
policy.
 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 to hospital 1
policy.
14. Administers Vitamin K (1mg/M) into the lateral 1
anterior thigh or vastus lateralis.
15. Keeps baby wrapped warmly under the floor lamp 1
or beside mother according to institutional policy
until discharge.
16. Records pertinent observations and nursing care 1
done.
17. Reports any signs of deviation/abnormality to the 1
pediatrician.
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND
EQUIPMENT
1. Prepares instrument and equipment needed. 4
 Suction bulb, cord clamp, gauze, cotton balls,
disinfectant, blanket, droplight, Vitamin K,
antimicrobial, ophthalmic ointment.
2. Ensures use of sterile equipment during immediate 1
care of the newborn.
3. Maintain adequacy of supplies as newborn care is 1
rendered.
4. Maintains orderliness of the working area. 1
 5. Observes precautionary measures related to use of 1
electrical equipment.
6. Ensures a warm and quiet environment. 1
7. Uses supplies diligently. 1
8. Ensures proper disposal of waste. 1
III. HEALTH EDUCATION
1. Provides instruction to the mother on daily cord 2
care and prevention of cord infection.
2. Provides discharge instructions to the mother on 1
when to expect cord to fall off or to report signs of
cord infection.
3. Provides information regarding newborn screening, 2
immunization, feeding, etc.
4. Responds to questions of mother and relatives 1
regarding expectations.
IV. LEGAL RESPONSIBILITY
1. Identifies newborn by comparing ID band with data 2
in the chart.
2. Documents all pertinent data correctly and 1
completely.
3. Reports accurately any deviations/abnormal 1
findings and nursing interventions rendered
4. Ensures that birth certificate and other civil 2
registration forms are accomplished/ filled out
according to institutional policy.
5. Performs foot printing according to hospital policy. 1
V. ETHICO-MORAL RESPONSIBILITY
1. Respects the religious, cultural and ethnic practices
of the family of the newborn.
2. Maintains privacy and confidentiality of findings of
assessments.
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT
1. Updates oneself with the latest trends and 1
developments in newborn care.
2. Projects a professional image of the pediatric nurse. 1
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards. 1
VII. QUALITY IMPROVEMENT
1. Identifies deviation of practice from the standards. 1
2. Participates in audit practices in the nursery. 1
3. Recommends corrective and preventive measures 1
for the identified deviations
VIII. RESEARCH
1. Identifies researchable problems related to 1
immediate care of newborn.
2. Initiates a research study on an identified 1
researchable problem.
3. Participates as a member of a research team in the 1
conduction of a research study.
4. Utilizes findings of research studies in the 1
immediate care of the newborn.
IX. RECORDS MANAGEMENT
1. Documents accurately relevant data about the 1
newborn.
2. Maintains an organized system of filling and record 1
keeping.
X. COMMUNICATION
1. Utilizes appropriately all forms of communication; 1
verbal, non-verbal, electronic.
2. Maintains an open line of communication with the 1
mother and other family members.
3. Informs mother of relevant information about the 1
 newborn.
4. Listens attentively to queries and request of 1
mothers and family members.
XI. COLLABORATION AND TEAMWORK
1. Functions effectively as a team player in the 1
nursery.
2. Communicates findings of assessment to all 1
concerned.
3. Establishes a collaborative relationship with 1
members of the health team and family of the
newborn.
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Clinical Instructor: ____________________

Date of Evaluation: ____________________

Conforme: Student’s Signature: ____________________

RUTH G. AGUILAR RN, MAN

Dean, College of Nursing
Date Signed:
Degree: BSN, RN, MAN
PRC NO: 0087885
Valid Until: July 12, 2013
PNA NO: 078418
Valid Until: December 2010
ADPCN NO: 0771
Valid Until: December 2010