UNIVERSITY OF ST.

LA SALLE
College of Nursing
La Salle Avenue, Bacolod City, 6100 Philippines, (034) 434-4010, nursing@usls.edu.ph

SUMMARY PERFORMANCE EVALUATION ACHIEVING

IMMEDIATE CARE OF THE NEWBORN COMPETENCY
In Accordance with PRC Board of Nursing Memorandum N0. 01 Series 2009

Signature over Printed Name of Student: ____________________________________________

DESIRED ACTUAL
NEWBORN COMPETENCIES
RATING 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 2
tag: name of the mother, date and time of delivery,
gender, and name of attending physician).
7. Performs physical assessment including 4
anthropometric measurements including weight,
height, head, chest, abdominal circumference.
8. Takes vital signs (temperature per rectum to check 1
patency).
9. Gives oil or water and soap bath according to 1
institutional policy.
10. Latches newborn to the mother's breast 1
immediately after birth.
11. Applies Crede's prophylaxis on the eyes. 1
12. 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.
13. Administers Vitamin K into the lateral anterior 1
thigh or vastus lateralis.
14. Keeps baby wrapped warmly under floor lamp or 1
beside the mother according to institutional policy
until discharge.
15. Records pertinent observations and nursing care 1
done.
16. Reports any signs of deviation or abnormality to 1
the pediatrician.
 DESIRED ACTUAL
NEWBORN COMPETENCIES
RATING RATING
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE)
1. Prepares instruments and equipments 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 1
care of the newborn.
3. Maintains 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 hospital waste. 1
III. HEALTH EDUCATION (HE)
1. Provides instructions 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 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 RESPONSIBILITIES (LR)
1. Identifies newborn by comparing ID band with 2
data in the chart.
2. Documents all pertinent data correctly and 1
completely.
3. Reports accurately any deviations or abnormal 1
findings and nursing interventions rendered.
4. Ensures that birth certificate and other civil 2
registration forms are accomplished or 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 1
of the family of the newborn.
2. Maintains privacy and confidentiality of findings 1
of assessment.
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 1
nurse.
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards. 1
 DESIRED ACTUAL
NEWBORN COMPETENCIES
RATING RATING
VII. QUALITY IMPROVEMENT (QI)
1. Identifies deviation of practice from the standards. 1
2. Participates (whenever possible) in audit practices 1
in the nursery.
3. Recommends corrective and preventive measures 1
for the identified deviations.
VIII. RESEARCH (R)
1. Identifies researchable problems related to 2
immediate care of the newborn.
2. Utilizes findings of research studies in the 2
immediate 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.
X. COMMUNICATION (Comm)
1. Utilizes appropriately all forms of communication: 1
verbal, non- verbal or 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 1
mothers and family members.
XI. COLLABORATION AND TEAMWORK (CTM)
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.
TOTAL SCORE 75

Certified True and Correct:

(Signature over Printed Names)

_________________________________ _______________________________
Clinical Instructor Clinical Coordinator
License Number: _____________________ License Number: __________________
PRC-Card Validity Date: ______________ PRC-Card Validity Date: ____________

_________________________________ _______________________________
DEAN Academic Year Graduated
License Number: _____________________
PRC-Card Validity Date: _______________