COLEGIO SAN AGUSTIN – BACOLOD

B.S. Aquino Drive, Bacolod City 6100, Philippines P.O. Box 120
Tel. Nos. (034) 434-2471 loc 162 : Telefax : (034) 433-9187
Email Address: chap@csab.edu.ph

COLLEGE OF HEALTH AND ALIED PROFESSIONS

NURSING PROGRAM

SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-PARTAL CARE COMPETENCY

In Accordance with the PRC Board of Nursing Memorandum No. 01 Series of 2009

Name of Student: ___________________________________________________________________

INTRAPARTAL COMPETENCIES DESIRED 1ST 2ND 3RD 4th 5th AVERAGE

RATING RLE RLE RLE RLE RLE RATING
I. SAFETY QUALITY NURSING CARE (SQC)
1. Obtain obstetrical history including Parity, Gravida
3
score, LMP, 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. Monitors progress of labor/uterine contraction as to:
 Frequency 1
 Duration 1
 Intensity 1
 Interval 1
7. Observes for the timely rupture membrane. 1
8. Coaches mother on process of labor. 1
II. PERFORMS FUNCTIONS DURING ACTUAL LABOR.
1. Transports clients while providing privacy. 2
2. Places mother lithotomy position. 1
3. Performs perineal care using sterile technique correctly. 2
4. Performs proper hand scrub. 1
5. Wearing gown and gloves according to hospital policy. 1
6. Performs Ritgen’s maneuver safely. 2
7. Coaches mother on breathing and pushing techniques. 1
8. Delivers baby and placenta carefully.
 Checks and manages cord recoil correctly 2
 Observe for cessation of pulsation in the umbilical 1
cord.
 Clamp and cut correctly 2
 Identify signs of placental separation 2
 Checks the characteristic/completeness of the 1
placenta
9. Assesses amount of blood loss (Normal: <500cc) 2
10. Employs interventions to achieve and maintain a well
contracted uterus to prevent/control hemorrhage.
 Uterine massage 1
 Correct administration of oxytocin 2
 Cold compress 1
11. Assesses presence and degree of laceration. 1
12. Assists in episiorraphy. 2
13. Checks, size, consistency and location of uterus. 1
 DESIRED 1ST 2ND 3RD 4th 5th AVERAGE
INTRAPARTAL COMPETENCIES
RATING RLE RLE RLE RLE RLE RATING
III. INTRAPARTAL COMPETENCIES
14. Performs perineal care and applies pad correctly. 2
15. Provides emotional support to the mother throughout
1
labor and delivery.
16. Evaluates patient’s condition and records pertinent
2
data accordingly.
17. Prepares patient for transfer to recovery room/ward. 1
IV. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENTS (MRE)
1. Prepares room, instruments and equipment needed
 Sterile drape 1
 Sterile instruments and equipment (forceps,
scissors, bulb syringe, gauze, suture, needle 1
holder, catheter(optional))
 Kelly pad 1
 Disinfectant 1
2. Performs sterilization procedures. 1
3. Maintains adequacy of supplies as delivery progresses. 1
4. Maintains orderliness of the sterile table. 1
5. Observes precautionary measures related to use of
1
electrical equipment.
6. Ensures a quiet environment 1
7. Uses supplies diligently. 1
8. Performs aftercare of the materials and equipment
1
used.
9. Ensures proper disposal of hospital waste including
2
blood and other fluids.
V. HEALTH EDUCATION
1. Teaches client on basic preparation during labor and
1
deliver.
2. Coaches client on breathing/bearing down technique. 1
3. Demonstrates proper “latch-on” breastfeeding
2
technique
4. Provides discharge instructions as to feeding, bathing,
administration of ordered medications, appointment dates 1
for post natal and well baby check up.
5. Responds to questions of clients and relatives regarding
1
expectations
VI. LEGAL RESPONSIBILITIES (LR)
1. Secures informed consent in all procedures related to
1
labor and delivery.
2. Reports accurately and honestly the gender, time of
2
delivery of the baby and placenta.
3. Ensures proper identification of the mother and
2
newborn.
4. Documents all pertinent data correctly and completely
2
and completely.
VII. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, cultural and ethnic practices of
1
the family of the woman in labor and delivery.
2. Promotes emotional security by supporting needs. 1
3. Ensures privacy and confidentiality. 1
VIII. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Updates oneself with the latest trends and development
1
in labor and delivery
2. Projects a professional image of a delivery room nurse. 1
3. Accepts criticisms and recommendations 1
4. Performs functions according to standards 1
IX. QUALITY IMPROVEMENT (QI)
1. Identifies deviation of practice from the standards. 1
2. Participates in audit practices in the delivery room/lying
1
in
DESIRED 1ST 2ND 3RD 4th 5th AVERAGE
INTRAPARTAL COMPETENCIES
RATING RLE RLE RLE RLE RLE RATING
3. Recommends corrective and preventive measures for
1
the identified deviations.
X. RESEARCH (R)
1. Identifies researchable problems related to labor and
1
delivery.
2. Initiates a research study on an identified researchable
1
problem.
3. Participates as a member of a research team in the
1
conduction of research study.
4. Utilize findings of research studies in intrapartal care. 1
XI. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about client. 2
2. Maintains an organized system of filing and keeping
1
records of the client
XII. COMMUNICATION (COMM)
1. Utilizes appropriately all forms of communication;
1
verbal, non-verbal, electronic
2. Informs client’s significant others of the progress of
1
labor and delivery
3. Listens attentively to clients and families queries and
1
requests.
XIII. COLLABORATION AND TEAMWORK (CTW)
1. Functions effectively as a team player in the delivery
1
room/lying in.
2. Communicates the progress of labor/delivery to
1
significant others.
3. Establishes collaborative relationships with members of
1
the health team and family members.
TOTAL SCORE: 100
When Graded RLE’s were performed:

First Graded RLE : Academic Year ____________ 1st Sem. _______ 2nd Sem. ______ Summer ________
Clinical Instructor : Name ____________________Signature _____________________
License Number ___________ Validity: ______________________

Second Graded RLE : Academic Year ____________ 1st Sem. _______ 2nd Sem. ______ Summer ________
Clinical Instructor : Name ____________________Signature _____________________
License Number ___________ Validity: ______________________

Third Graded RLE : Academic Year ____________ 1st Sem. _______ 2nd Sem. ______ Summer ________
Clinical Instructor : Name ____________________Signature _____________________
License Number ___________ Validity: ______________________

Fourth Graded RLE : Academic Year ____________ 1st Sem. _______ 2nd Sem. ______ Summer ________
Clinical Instructor : Name ____________________Signature _____________________
License Number ___________ Validity: ______________________

Fifth Graded RLE : Academic Year ____________ 1st Sem. _______ 2nd Sem. ______ Summer ________
Clinical Instructor : Name ____________________Signature _____________________
License Number ___________ Validity: ______________________

Verified True and Correct :_______________________ License Number: ___________________

Clinical Coordinator Validity Date : __________________
Academic Year Graduated : _______________________

___________________________ License Number:___________________

Dean Validity Date: _____________________