ST.

PAUL COLLEGE OF ILOCOS SUR

Member: St. Paul University System (SPUS)
2727 St. Paul Avenue, Bantay Ilocos Sur
www.spcis.edu.com

SUMMARY PERFORMANCE EVALUATION ACHIEVING

INTRA-PARTAL CARE COMPETENCY
In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Name of Student: ANGELY JOY LUCZON MINA

INTRAPARTAL COMPETENCIES DESIRED

RATING
ACTUAL
RATING
I. SAFE AND QUALITY NURSING CARE (SQC)
1. Obtains obstetrical history including parity, gravida score, LMP, 4
EDC, AOG, BOW onset of true labor.
2. Checks vital signs. 1
3. Conducts physical examination. 2
4. Performs Leopold’s maneuver. 2
5. Checks Fetal Heart Rate and Fundic height. 2
6. Monitor progress of labor/ uterine contractions as to:
 Frequency 1
 Duration 1
 Intensity 1
 Interval 1
7. Observes for the timely rupture of membrane. 1
8. Coaches mother on process of labor. 2
PERFORMS FUNCTIONS DURING ACTUAL LABOR
 Transports clients safely while providing privacy. 1
 Places mother in lithotomy position. 1
 Performs perineal care using sterile technique correctly. 1
 Performs proper hand scrub. 1
 Wears gown and gloves according to hospital policy. 1
 Performs Ritgen’s maneuver safely. 2
 Coaches mother on breathing and pushing techniques. 1
 Delivers baby and placenta carefully.
 Checks and manages cord recoil correctly 1
 Clamps and cuts the cord correctly 1
 Identify signs of placental separation 1
 Checks the characteristic/ completeness of the placenta 1
 Assesses amount of blood loss (Normal: <500 cc) 2
 Employs interventions to achieve and maintain a well
contracted uterus to prevent/control hemorrhage.
 Uterine massage 1
 Correct administration of oxytocin 1
 Cold compress 1
 Assesses presence and degree of laceration. 1
 Assists in episiorrhaphy. 1
 Checks size, consistency and location of uterus. 1

Board of Nursing
 INTRAPARTAL COMPETENCIES
14.Performs perineal care and applies pad correctly. 1
15.Provides emotional support to the mother throughout labor and 1
delivery.
16.Evaluates patient’s condition and records pertinent data 2
accordingly.
17.Prepares patient for transfer to recovery room/ ward. 1
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE)
1. Prepares room, instruments and equipment needed.
 Sterile drape 1
 Sterile instruments and equipment [Forceps, scissors, bulb 1
syringe, gauze, suture, needle holder, catheter (optional)]
 Kelly pad 1
 Disinfectant 1
2. Performs sterilization procedure. 1
3. Maintains adequacy of supplies as the delivery progresses. 1
4. Maintains orderliness of the sterile table.
5. Observes precautionary measures related to use of electrical 1
equipment.
6. Ensures a quiet environment. 1
7. Uses supplies diligently. 1
8. Performs after care of the materials and equipments used. 1
9. Ensures proper disposal of hospital waste including blood and 1
other fluids.
III. HEALTH EDUCATION (HE)
1. Teaches client on basic preparation during labor and deliver 1
(can be done in the labor room)
2. Coaches’ client on breathing/ bearing down technique. 2
3. Demonstrates proper “latch-on” breast feeding technique 1
(done post-partum period).
4. Gives instructions to parents regarding infant care before 1
discharge (done post-partum period.)
5. Provides discharge instructions as to feeding, bathing, 1
administration of ordered medications, appointment dates for
post natal and well babycheck up(done post-partum period.)
6. Responds to questions of clients and relatives regarding 1
expectations.
IV. LEGAL RESPONSIBILITIES (LR)
1. Secures informed consent in all procedures related to labor and 1
delivery.
2. Reports accurately and honestly the gender, time of delivery of 2
the baby and placenta.
3. Ensures proper identification of the mother and newborn. 2
4. Documents all pertinent data correctly and completely. 1
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, cultural and ethnic practices of the family 1
of the woman in labor and delivery.
2. Promotes emotional security by supporting needs. 1
3. Ensures privacy and confidentiality. 1
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Updates oneself with the latest trends and development in labor 1
and delivery.
INTRAPARTAL COMPETENCIES
2. Projects a professional image of a delivery room nurse. 1
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards. 1

Board of Nursing
 VII. QUALITY IMPROVEMENT (QI) (preferably done during post conferences)
1. Identifies deviation of practice from the standards. 1
2. Participates in audit practices in the delivery room/lying in. 1
3. Recommends corrective and preventive measures for the 1
identified deviations.
VIII. RESEARCH (R) (preferably done during post conferences)
1. Identifies researchable problems related to labor and delivery. 2
2. Utilize findings of research studies in intra-partal care. 2
IX. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about client. 1
2. Maintains an organized system of filing and keeping records of 1
the client.
X. COMMUNICATION (Comm)
1. Utilizes appropriately all forms of communication; verbal, non- 1
verbal, electronic.
2. Inform client’s significant others of the progress of labor and 1
delivery.
3. Listens attentively to clients and families queries and requests. 1
XI. COLLABORATION AND TEAMWORK (CTW)
1. Functions effectively as a team player in the delivery room/lying 1
in.
2. Communicates the progress of labor/delivery to significant 1
others.
3. Establishes collaborative relationship with members of the 1
health team and family members.
TOTAL SCORE: 90

Certified True and Correct: ANGELY JOY LUCZON MINA

ROWENA QUITORIANO, RN, MSN KATHLEEN R. PAREL, RN, MAN

Clinical Instructor RLE Coordinator
License Number: 0180976 License Number: 0507029
PRC Card – Validity Date: December 30, 2024 PRC Card – Validity Date: March 10, 2025

SR. CAROLINA S. AGRAVANTE, RN, PhD

DEAN
License Number: 0022675 2022______
PRC Card – Validity Date: June 23, 2023 Academic Year Graduated

Board of Nursing
 SUMMARY PERFORMANCE EVALUATION ACHIEVING
IMMEDIATE CARE OF THE NEWBORN COMPETENCY
In Accordance with PRC Board of Nursing Memorandum
No. 01 Series 2009

Name of Student: ANGELY JOY LUCZON MINA

NEWBORN COMPETENCIES DESIRED

RATING
ACTUAL
RATING
I. SAFE AND QUALITY NURSING CARE (SQC)
1. Establishes and maintains patent airway. 3
2. Puts the 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 including anthropometric 4
measurements including weight, height, head, chest,
abdominal circumference.
8. Takes vital signs (temperature per rectum to check 1
patency)
9. Gives oil/ water and soap bath according to institutional 1
policy.
10. Latches newborn to the mother’s breast immediately 1
after birth.
11. Applies CREDE’s prophylaxis on the eyes. 1
12. Performs cord dressing aseptically.
 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 1
13. Administers Vitamin K (1 mg/M) into the lateral anterior 1
thigh or vastus lateralis.
14. Keeps baby wrapped warmly under floor lamp or beside 1
mother according to institutional policy until discharge.
15. Records pertinent observations and nursing care done. 1
16. Reports any signs of deviation/abnormality to the 1
pediatrician.
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE)
1. Prepares instrument and equipment needed
 Suction bulb, cord clamp, gauze, cotton balls, 4
disinfectant, blanket, droplight, Vitamin K,
antimicrobial ophthalmic ointment.
2. Ensures use of sterile equipment during immediate care 1
of the newborn.
3. Maintain adequacy of supplies as newborn care is 1
rendered

Board of Nursing
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 hospital waste. 1
III. HEALTH EDUCATION (HE)
1. Provides instructions to the mother on daily cord care 2
and prevention of cord infection.
2. Provides discharge instructions to the mother on when 1
to expect cord to fall off or to report signs of cord
infection.
3. Provides information regarding newborn screening, 1
immunization, feeding, etc.
4. Responds to questions of mother and relatives 1
regarding expectations.
IV. LEGAL RESPONSIBILITIES (LR)
1. Identifies newborn by comparing ID band with data in 2
the chart.
2. Documents all pertinent data correctly and completely. 1
3. Reports accurately any deviations/abnormal findings 1
and nursing interventions rendered.
4. Ensures that birth certificate and other civil registration 2
forms are accomplished/ filled out according to
institutional policy.
5. Performs foot printing according to hospital policy. 1
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, cultural and ethnic practices of 1
the family of the newborn.
2. Maintains privacy and confidentiality of findings of 1
assessments.
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
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 (QI)
1. Identifies deviation of practice from the standards. 1
2. Participates (whenever possible) in audit practices in 1
the nursery.
3. Recommends corrective and preventive measures for 1
the identified deviations.
VIII. RESEARCH (R)
1. Identifies researchable problems related to immediate 2
care of newborn.
2. Utilizes findings of research studies in the immediate 2
care of the newborn.
IX. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about the 1
newborn.
2. Maintains an organized system of filing and record 1
keeping.

Board of Nursing

X. COMMUNICATION (Comm)
 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 requests of mothers 1
and family members.
XI. COLLABORATION AND TEAMWORK (CTM)
1. Functions effectively as a team player in the nursery. 1
2. Communicates findings of assessment to all concerned. 1
3. Establishes a collaborative relationship with members 1
of the health team and family of the newborn.
TOTAL SCORE: 75

Certified True and Correct: ANGELY JOY LUCZON MINA

ROWENA QUITORIANO, RN, MSN KATHLEEN R. PAREL, RN, MAN

Clinical Instructor RLE Coordinator
License Number: 0180976 License Number: 0507029
PRC Card – Validity Date: December 30, 2024 PRC Card – Validity Date: March 10, 2025

SR. CAROLINA S. AGRAVANTE, RN, PhD

DEAN
License Number: 0022675 2022________
PRC Card – Validity Date: June 23, 2023 Academic Year Graduated

Board of Nursing
 ST. PAUL COLLEGE OF ILOCOS SUR
Member: St. Paul University System (SPUS)
2727 St. Paul Avenue, Bantay Ilocos Sur
www.spcis.edu.com

SUMMARY PERFORMANCE EVALUATION ACHIEVING

INTRA- OPERATIVE CARE COMPETENCY
In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Name of Student: ANGELY JOY LUCZON MINA

INTRA- OPERATIVE CARE COMPETENCIES DESIRED 1st 2nd 3rd AVERAGE

RATING RLE RLE RLE
RATING
I. SAFE AND QUALITY NURSING CARE (SQC)
1. Utilizes the nursing process in the care of OR client
a. Obtains comprehensive client’s information by 4
checking complete accomplishment of the
preoperative checklist / client’s check.
b. Identifies priority needs of the client at the 4
operating room.
c. Provides needed nursing interventions based 4
on identified needs.
d. Monitors client’s responses to surgery. 2
2. Promotes safety and comfort of patients inside the 2
OR.
3. performs the functions of a scrub nurse 4
a. Performs surgical scrub correctly.
b. Wears sterile gloves and gowns aseptically. 2
c. Prepares surgical instruments, sponges, 2
sutures and other supplies in functional
arrangement.
d. Hands instrument, sponges, sutures and other 2
needed materials according to surgeon’s
preference.
e. Performs surgical count accurately. 2
4. Performs the functions of the circulating nurse 2
a. Anticipates the needs of the surgical team.
b. Sets up the OR room and needed equipment. 2
c. Receives client for surgery/ endorses client 2
post operatively.
d. Assists in skin preparations and draping of 2
client.
5. Administers medication and other health therapeutic 2
safety
II. MANAGEMENT OF RESOURCES AND ENVIRONMENT (MRE)
1. Organizes work load to facilitate timely patient Care 4
2. Utilizes adequate and appropriate resources to 2
support the OR team
3. Ensures functionality of OR resources 2
4. Maintains a safe environment at the OR by 2
observing the principles asepsis

Board of Nursing
III. HEALTH EDUCATION (HE)
 1. Implements appropriate health education activities 2
to client based on needs assessment
IV. LEGAL RESPONSIBILITIES (LR)
1. Adheres to legal and institutional protocols regarding 2
informed consent.
V. ETHICO- MORAL RESPONSIBILITIES (EMR)
1. Respects the rights of the OR client 2
2. Accepts responsibility and accountability for own 2
decisions and actions as an OR nurse
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1.Performs OR functions according to professional 4
standards
2. Possesses positive attitude towards learning 2
surgical and OR related knowledge and skills
VII. QUALITY IMPROVEMENT (QI)
1. Participates in quality improvement activities related 2
to infection control and successful OR operations
2. Identifies and reports variances in sterility and other 2
OR activities
VIII. RESEARCH (R)
1. Disseminates results of OR-related research 2
findings to clinical group and other members of the OR
team
as appropriate
IX. RECORDS MANAGEMENT (RM)
1. Maintain accurate and updated documentation of 2
patient care
X. COMMUNICATION (Comm)
1. Establishes rapport with patients, significant others 1
and members of the health team
2. Uses appropriate information mechanisms to 2
facilitate communication inside the OR and with other
departments in the hospital
XI. COLLABORATION AND TEAMWORK (CTM)
1. Collaborates plan of care with other members of the 2
team
TOTAL SCORE 75

Certified True and Correct: ANGELY JOY LUCZON MINA

ROWENA QUITORIANO, RN, MSN KATHLEEN R. PAREL, RN, MAN

Clinical Instructor RLE Coordinator
License Number: 0180976 License Number: 0507029
PRC Card – Validity Date: December 30, 2024 PRC Card – Validity Date: March 10, 2025

SR. CAROLINA S. AGRAVANTE, RN, PhD

DEAN
License Number: 0022675 2022________
PRC Card – Validity Date: June 23, 2023 Academic Year Graduated

Board of Nursing