OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Valenzuela

PROGRAM Bachelor of Science in Nursing STUDENT NAME

YEAR AND SECTION
COURSE NCMA 217 RLE INSTRUCTOR
DATE

PROCEDURE : NORMAL SPONTANEOUS DELIVERY

EXPECTED OUTCOME : The student should be able to demonstrate normal spontaneous delivery correctly.
ASSESSMENT TASK : Return Demonstration

Exceptional Good Average Poor

Assessment Dimension SCORE
(3) (2) (1) (0)
1. Gather necessary Performed the Performed but Performed with Failed to
materials for perineal procedure needs minimal slight difficulty, perform the
preparation and accurately with supervision needs supervision procedure
vaginal delivery evident ease most of the time
without supervision
2. Greet and identify Greet and explained Greet and explained Greet and explained Failed to greet
the client. Explain the procedure to the procedure but the procedure but the patient.
procedure the client and lacks details in an unclear
significant others manner Failed to explain
clearly the procedure
3. Provide adequate Demonstrated the Demonstrated the Demonstrated the Failed to
privacy and wear procedures with procedure with little procedure with perform the
clean gloves for ease errors some errors procedure
perineal preparations
4. After the perineal Demonstrated the Demonstrated the Demonstrated the Failed to
preparation, transfer procedures with procedure with little procedure with perform the
client to the delivery ease errors some errors procedure
room & place in
lithotomy position.
5. Put on sterile gloves Performed the Performed but Performed with Failed to
and apply povidone procedure needs minimal slight difficulty, perform the
iodine from the accurately with supervision needs supervision procedure
meatus then the evident ease most of the time
labias, inner aspect of without supervision
thigh & mons pubis.
Afterwards, provide
sterile drape.
6. Open the sterile kit. Performed the Performed but Performed with Failed to
Add and prepare procedure needs minimal slight difficulty, perform the
materials needed. accurately with supervision needs supervision procedure
evident ease most of the time
without supervision
7. Maintain room Performed the Performed but Performed with Failed to
temperature at 25 – procedure needs minimal slight difficulty, perform the
28 degree centigrade. accurately with supervision needs supervision procedure
evident ease most of the time
without supervision

8. Don sterile gloves Performed the Performed but Performed with Failed to
procedure needs minimal slight difficulty, perform the
accurately with supervision needs supervision procedure
evident ease most of the time
without supervision
9. Assist doctor during Performed the Performed but Performed with Failed to
the delivery. procedure needs minimal slight difficulty, perform the
accurately with supervision needs supervision procedure
 evident ease most of the time
without supervision
10. Perform RITGEN’S Performed the Performed but Performed with Failed to
maneuver upon procedure needs minimal slight difficulty, perform the
crowning to delivery accurately with supervision needs supervision procedure
head evident ease most of the time
without supervision
11. Check for presence of Demonstrated the Demonstrated the Demonstrated the Failed to
cord coil. procedures with procedure with little procedure with perform the
ease errors some errors procedure
12. Assist head in Performed the Performed but Performed with Failed to
external rotation by procedure needs minimal slight difficulty, perform the
supporting the neck. accurately with supervision needs supervision procedure
Deliver the anterior & evident ease most of the time
posterior shoulder without supervision
then the rest of the
body,
13. After the expulsion, Performed the Performed but Performed with Failed to
call for baby out, procedure needs minimal slight difficulty, perform the
note the time of accurately with supervision needs supervision procedure
delivery and the evident ease most of the time
gender of the baby without supervision
ESSENTIAL INTRAPARTUM
NEWBORN CARE
14. Immediate and Performed the Performed but Performed with Failed to
thorough drying of procedure needs minimal slight difficulty, perform the
the newborn. Place accurately with supervision needs supervision procedure
the new born on the evident ease most of the time
mother’s abdomen without supervision
and dry up within 30
seconds.
15. Initiate early skin to Performed the Performed but Performed with Failed to
skin contact. After 30 procedure needs minimal slight difficulty, perform the
seconds, remove the accurately with supervision needs supervision procedure
wet blanket and get a evident ease most of the time
dry one. without supervision
16. Put on the bonnet Performed the Performed but Performed with Failed to
and the identification procedure needs minimal slight difficulty, perform the
bracelet accurately with supervision needs supervision procedure
evident ease most of the time
without supervision
17. Administer 10 units Performed the Performed but Performed with Failed to
of oxytocin into the procedure needs minimal slight difficulty, perform the
deltoid region of the accurately with supervision needs supervision procedure
mother. Remove 1st evident ease most of the time
sets of gloves. without supervision
18. Proper timed cord Performed the Performed but Performed with Failed to
clamping. Hold the procedure needs minimal slight difficulty, perform the
cord and wait 1-3 accurately with supervision needs supervision procedure
minutes or until the evident ease most of the time
pulsation stops. without supervision
19. Non-separation of Performed the Performed but Performed with Failed to
the mother from the procedure needs minimal slight difficulty, perform the
newborn to initiate accurately with supervision needs supervision procedure
early breastfeeding. evident ease most of the time
Nudge the baby to without supervision
the breast of the
mother and observe
the newborn for
feeding cues
20. Deliver placenta Performed the Performed but Performed with Failed to
through controlled procedure needs minimal slight difficulty, perform the
 cord traction with accurately with supervision needs supervision procedure
counter traction. evident ease most of the time
Assess placenta & without supervision
observe for degree of
laceration.
21. Assist doctor in Performed the Performed but Performed with Failed to
episiorrhaphy. Do procedure needs minimal slight difficulty, perform the
after care of area. accurately with supervision needs supervision procedure
Remove soiled evident ease most of the time
gloves. without supervision
22. Transfer client in Performed the Performed but Performed with Failed to
recovery room for procedure needs minimal slight difficulty, perform the
proper monitoring. accurately with supervision needs supervision procedure
evident ease most of the time
without supervision
23. Handwashing and Washed hands and Washed hands and Washed hands but Washed hands
documentation documented the some of the details most of the details but
information about of procedure were of the procedure documentation
the procedure not documented. were not was not done.
properly and documented
completely.

OVERALL SCORE: ________________

Target raw score: 52 out of 69. If raw score is less than 52, repeat the demonstration.

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FACULTY SIGNATURE OVER PRINTED NAME