OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Pampanga

Bachelor of Science
PROGRAM STUDENT NAME
in Nursing
YEAR AND SECTION
COURSE NCMA 217 INSTRUCTOR
DATE

PROCEDURE : NORMAL SPONTANEOUS DELIVERY

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

Exceptional Good Average Poor

Assessment Dimension SCORE
(4) (3) (2) (1)
1. Gather necessary Performed the Performed but Performed with Failed to
materials for procedure needs minimal slight difficulty, perform the
perineal accurately with supervision needs supervision procedure
preparation and evident ease most of the time
vaginal delivery without
supervision
2. Greet and identify Greet and Greet and Greet and Failed to greet
the client. Explain explained the explained the explained the the patient.
procedure procedure to the procedure but procedure but in
client and lacks details an unclear Failed to
significant others manner explain the
clearly procedure
3. Provide adequate Demonstrated the Demonstrated the Demonstrated the Failed to
privacy and wear procedures with procedure with procedure with perform the
gloves for perineal ease little errors some errors procedure
preparations
4. Place waterproof Performed the Performed but Performed with Failed to
pad and place the procedure needs minimal slight difficulty, perform the
client in back lying accurately with supervision needs supervision procedure
position with knees evident ease most of the time
flexed and spread without
well apart. supervision
5. Clean the perineal Performed the Performed but Performed with Failed to
area. First the procedure needs minimal slight difficulty, perform the
meatus down, then accurately with supervision needs supervision procedure
labia minora and evident ease most of the time
labia majora using without
the figure of seven supervision
strokes. Do proper
shaving of
perineum. Rinse
with lukewarm
water.
6. After the perineal Demonstrated the Demonstrated the Demonstrated the Failed to
preparation, procedures with procedure with procedure with perform the
transfer client to ease little errors some errors procedure
the delivery room
& place in
lithotomy position.
7. Apply povidone Performed the Performed but Performed with Failed to
iodine from the procedure needs minimal slight difficulty, perform the
meatus then the accurately with supervision needs supervision procedure
labia majora and evident ease most of the time
minora, inner without
aspect of thigh & supervision
mons pubis.
Afterwards, provide
sterile drape.
8. 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
9. Maintain room Performed the Performed but Performed with Failed to
temperature at 25 procedure needs minimal slight difficulty, perform the
– 28 degree accurately with supervision needs supervision procedure
centigrade. evident ease most of the time
without
supervision

10. Apply 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
11. 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
12. Perform RITGEN’S Performed the Performed but Performed with Failed to
maneuver upon procedure needs minimal slight difficulty, perform the
crowning to accurately with supervision needs supervision procedure
delivery head evident ease most of the time
without
supervision
13. Check for the Demonstrated the Demonstrated the Demonstrated the Failed to
presence of cord procedures with procedure with procedure with perform the
coil. ease little errors some errors procedure

14. Assist head in Performed the Performed but Performed with Failed to
 external rotation by procedure needs minimal slight difficulty, perform the
supporting the accurately with supervision needs supervision procedure
neck. Deliver the evident ease most of the time
anterior & without
posterior shoulder supervision
then the rest of the
body,
15. After the expulsion, Performed the Performed but Performed with Failed to
note the time of procedure needs minimal slight difficulty, perform the
delivery. Place the accurately with supervision needs supervision procedure
newborn on the evident ease most of the time
mother’s abdomen. without
Do quick drying. supervision
Administer 10 units
of oxytocin into the
deltoid region of
the mother.
16. Do proper cutting Performed the Performed but Performed with Failed to
of the umbilical procedure needs minimal slight difficulty, perform the
cord. Wait 1-3 accurately with supervision needs supervision procedure
minutes or until the evident ease most of the time
pulsation stops. without
supervision
17. 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
observe for degree supervision
of laceration.
18. Assist doctor in Performed the Performed but Performed with Failed to
episiorrhaphy. Do procedure needs minimal slight difficulty, perform the
aftercare in the accurately with supervision needs supervision procedure
area. Remove evident ease most of the time
soiled gloves. without
supervision
19. 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
20. Handwashing and Washed hands Washed hands Washed hands but Washed hands
documentation and documented and some of the most of the details but
the information details of of the procedure documentation
about the procedure were were not was not done.
procedure not documented. documented
properly and
completely.
 OVERALL SCORE: ________________

Target raw score: 60 out of 80. If the raw score is less than 60, repeat the demonstration.

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FACULTY SIGNATURE OVER PRINTED NAME