CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH CARE TECHNOLOGY Nabua, Camarines Sur (054) 288-4421-23 loc 127

cspc.chct@gmail.com

SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-PARTAL CARE COMPETENCY Signature over Printed Name of Student: ________________________________________________________________ INTRAPARTAL COMPETENCIES I. SAFE AND QUALITY NURSING CARE (SQC) 1. Obtains obstetrical history including parity, gravida score, LMP, EDC, AOG, BOW onset of true labor 2. Checks vital signs 3. Conducts physical examination. 4. Performs Leopolds maneuver 5. Checks Fetal Heart Rate and Fundic height 6. Monitor progress of labor/uterine contractions as to: y Frequency y Duration y Intensity y Interval 7. Observes for the timely rupture of membrane 8. Coaches mother on process of labor PERFORMS FUNCTIONS DURING ACTUAL LABOR 1. Transport clients safely while providing privacy 2. Places mother in lithotomy position 3. Performs perineal care using sterile technique correctly 4. Performs proper hand scrub. 5. Wears gown and gloves according to hospital policy. 6. Performs Ritgensmanuever safety. 7. Coaches mother on breathing and pushing techniques. 8. Delivers baby and placenta carefully. y Checks and manages cord recoil correctly. y Clamps and cluts the cord correctly. y Identify signs of placental separation. y Checks the characteristics/completeness of the placenta 9. Assesses amount of blood loss (Normal: <500cc) 10. Employs interventions to achieve and maintain a well contracted uterus to prevent/control DESIRED RATING 4 1 2 2 2 1 1 1 1 1 2 1st RLE 2nd RLE 3rd RLE AVERAGE RATING

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hemorrhage. y Uterine massage y Correct administration of oxytocin y Cold compress 11. Assesses presence and degree of laceration 12. Assists in episiorrhaphy 13. Checks size, consistently and location of uterus. INTRAPARTAL COMPETENCIES 14. Performs perineal care and applies pad correctly. 15. Provides emotional support to the mother throughout labor and delivery. 16. Evaluates patients condition and records pertinent data accordingly. 17. Prepares patient for transfer to recovery room/ward. II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE) 1. Prepares room, instruments and equipment needed. y Sterile drape y Sterile instruments and equipment (Forceps, scissors, bulb syringe, gauze, suture, needle holder, catheter [optional]) y Kelly pad y Disinfectant 2. Performs sterilization procedure 3. Maintains adequacy of supplies as the delivery progresses 4. Maintains orderliness of the sterile table 5. Observes precautionary measures related to use of electrical equipment 6. Ensures a quiet environment 7. Uses supplies diligently 8. Performs after care of the materials and equipment used. 9. Ensures proper disposal of the hospital waste including blood and other fluids. III. HEALTH EDUCATION (HE) 1. Teaches client on basic preparation during labor and deliver 2. Coaches client on breathing/bearing down techniques. 3. Demonstrates proper latch-on breast feeding technique. 4. Gives instructions to parents regarding infant care before discharge. 5. Provides discharge instructions as to feeding, bathing, administration of ordered medications, appointment dates for post natal and wellbabycheckup. 6. Responds to questions of clients and relatives

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regarding expectations. IV. LEGAL RESPONSIBILITIES (LR) 1. Secures informed consent in all procedures related to labor and delivery. 2. Reports accurately and honestly the gender, time of delivery of the baby and placenta. 3. Ensures proper identification of the mother and newborn. 4. Documents all pertinent data correctly and completely. V. ETHICO_MORAL RESPONSIBILITIES 1. Respects the religious, cultural and ethnic practices of the family of the woman in labor and delivery. 2. Promotes emotional security by supporting needs. 3. Ensures privacy and confidentiality. VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Updates oneself with the latest trends and development in labor and delivery. INTRAPARTAL COMPETENCIES 2. Projects a professional image of a delivery room nurse. 3. Accepts criticisms and recommendations. 4. Performs functions according to standards. VII. QUALITY IMPROVEMENT (QI) 1. Identifies deviation of practice from the standards. 2. Participates in audit practices in the delivery room/lying in. 3. Recommends corrective and preventive measures for the identified deviations. VIII. RESEARCH (R) 1. Identifies researchable problems related to labor and delivery. 2. Initiates a research study on an identified researchable problem. 3. Participates as a member of a research team in the conduction of a research study. 4. Utilize findings of research studies in intra-partal care. IX. RECORDS MANAGEMENT (RM) 1. Documents accurately relevant data about client. 2. Maintains an organized system of filing and keeping records of the client. X. COMMUNICATION (Comm) 1. Utilizes appropriately all forms of communication; verbal, non-verbal, electronic 2. Informs clients significant others of the progress of labor and delivery. 3. Listens attentively to clients and families queries

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and requests. XI. COLLABORATION AND TEAMWORK (CTW) 1. Functions effectively as a team player in the delivery room/lying-in. 2. Communicates the progress of labor/delivery to significant others. 3. Establishes collaborative relationship with members of the health team and family members. TOTAL

1 1 1 90

When Graded RLEs were Performed (Specify Academic year and Semester); First Graded RLE Clinical Instructor :Academic Year ____________ 1st Sem. ____ 2nd Sem. ____ Summer _____ Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________

Second Graded RLE :Academic Year ____________ 1stSem ____ 2ndSem _____ Summer _____ Clinical Instructor Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________ Third Graded RLE Clinical Instructor :Academic Year ____________ 1st Sem. ____2nd Sem. _____ Summer ____ Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________ ________________________________________ (Signature over Printed Name) Clinical Coordinator License Number _______________________ Validity ______________________________ : _______________________________________

Verified True and Correct:

Academic Year Graduated

_______________________________________ (Signature Over Printed Name) DEAN License Number: ______________________ Validity Date : _________________________

CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH CARE TECHNOLOGY Nabua, Camarines Sur (054) 288-4421-23 loc 127 cspc.chct@gmail.com SUMMARY PERFORMANCE EVALUATION ACHIEVING CARE OF THE NEWBORN COMPETENCY Signature over Printed Name of Student: ________________________________________________________________ NEWBORN COMPETENCIES I. 1. 2. 3. 4. SAFE AND QUALITY NURSING CARE (SQC) Establishes and maintains patent airway Puts the newborn in Trendelenburg position. Suctions mouth and nose of the newborn gently. Dries newborn and wraps warmly. y Places under droplight as needed 5. Performs and interprets APGAR scoring correctly. y Immediately after delivery y After 5 minutes 6. Ensures proper identification of newborn (name tag: name of mother, date and time of delivery, gender and name of the attending physician). 7. Performs physical assessment 8. Takes anthropometric measurements including weight, height, head, chest, abdominal circumference. 9. Takes vital signs (temperature per rectum to check patency) 10. Gives oil water and soap bath according to institutional policy. 11. Latches newborn to the mothers breast immediately after birth. 12. Applies CREDEs prophylaxis on the eyes. 13. Performs cord dressing aseptically. y Disinfects area properly according to hospital policy. y Clamps and cuts cord 1 inch from the abdomen y Checks for the presence of 2 arteries and 1 vein y Dresses cord aseptically according hospital policy 14. Administers Vitamin K (1mg/M) into the lateral anterior thigh or vastuslateralis. DESIRED RATING 3 1 2 1 2 2 2 1st RLE 2nd RLE 3rd RLE AVERAGE RATING

2 2

1 1 1 1 1 1 1 1

15. Keeps baby wrapped warmly under floor lamp or beside mother according to institutional policy until discharge. 16. Records pertinent observations and nursing care done 17. Reports any signs of deviation/abnormality to the pediatrician. II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE) 1. Prepares instrument and equipment needed y Suction bulb, cord clamp, gauze, cotton balls, disinfectant, blanket, droplight, Vitamin K, antimicrobial ophthalmic ointment 2. Ensures use of sterile equipment during immediate care of the newborn. 3. Maintain adequacy of supplies as newborn care is rendered. 4. Maintains orderliness of the working area. 5. Observes precautionary measures related to use of electrical equipment. 6. Ensures a warm and quiet environment 7. Uses supplies diligently. 8. Ensures proper disposal of hospital waste. III. HEALTH EDUCATION (HE) 1. Provides instructions to the matter on daily cord care and prevention of cord infection. 2. Provides discharge instructions to the mother on when to expect cord to fall off or to report signs of cord infection 3. Provides Information regarding newborn screening, immunization, feeding, etc. 4. Responds to questions of mother and relatives regarding expectations IV. LEGAL RESPONSIBILITIES (LR) 1. Identifies newborn by comparing ID band with data in the chart.. 2. Documents all pertinent data correctly and completely. 3. Reports accurately any deviations/ abnormal findings and nursing interventions rendered. 4. Ensures that birth certificate and other civil registration forms are accomplished filled out according to institutional policy. 5. Performs foot printing according to hospital policy. V. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. Respects the religious, cultural and ethnic practices of the family of the newborn. 2. Maintains privacy and confidentiality of findings of assessments. VI. PERSONAL AND PROFESSIONAL

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DEVELOPMENT (PPD) 1. Updates oneself with the latest trends and developments in newborn care. 2. Projects a professional image of the pediatric nurse. 3. Accepts criticisms and recommendations. 4. Performs functions according to standards. VII. QUALITY IMPROVEMENT (QI) 1. Identifies deviation of practice from the standards. 2. Participates in audit practices in the nursery. 3. Recommends corrective and preventive measures for the identified deviations. VIII. RESEARCH (R) 1. Identifies researchable problems related to immediate care of newborn. 2. Initiates a research study on an identified researchable problem. 3. Participates as a member of a research team in the conduction of a research study. 4. Utilizes findings of research studies in the immediate care of the newborn IX. RECORDS MANAGEMENT (RM) 1. Documents accurately relevant data about the newborn. 2. Maintains an organized system of filing and record keeping. X. COMMUNICATION (Comm) 1. Utilizes appropriately all forms of communication, verbal, non-verbal, electronic. 2. Maintains an open line of communication with the mother and other family members 3. Informs mother of relevant information about the newborn. 4. Listens attentively to queries and requests of mothers and family members. XI. COLLABORATION AND TEAMWORK (CTM) 1. Functions effectively as a team player in the nursery. 2. Communications findings of assessment to all concerned 3. Establishes a collaborative relationship with members of the health team and family of the newborn. TOTAL

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75

When Graded RLEs were Performed (Specify Academic year and Semester); First Graded RLE Clinical Instructor :Academic Year ____________ 1st Sem. ____ 2nd Sem. ____ Summer _____ Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________

Second Graded RLE :Academic Year ____________ 1stSem ____ 2ndSem _____ Summer _____ Clinical Instructor Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________ Third Graded RLE Clinical Instructor :Academic Year ____________ 1st Sem. ____2nd Sem. _____ Summer ____ Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________ ________________________________________ (Signature over Printed Name) Clinical Coordinator License Number _______________________ Validity ______________________________ : _______________________________________

Verified True and Correct:

Academic Year Graduated

_______________________________________ (Signature Over Printed Name) DEAN License Number: ______________________ Validity Date : _________________________

CAMARINES SUR POLYTECHNIC COLLEGES COLLEGE OF HEALTH CARE TECHNOLOGY Nabua, Camarines Sur (054) 288-4421-23 loc 127 cspc.chct@gmail.com SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-OPERATIVE CARE COMPETENCY Signature over Printed Name of Student: ________________________________________________________________ INTRA-OPERATIVE CARE COMPETENCIES DESIRED RATING 1st RLE 2nd RLE 3rd RLE AVERAGE RATING

I.
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II.

SAFE AND QUALITY NURSING (SQC) Utilizes the nursing process in the care of OR client a. Obtains comprehensive clients information by checking complete accomplishment of the preoperative checklist/clients chart. b. Identifies priority needs of the client at the Operating Room. c. Provides needed nursing interventions based on identified needs. d. Monitors clients responses to surgery. Promotes safety and comfort of patients inside the OR Performs the functions of the scrub nurse a. Performs surgical scrub correctly b. Wears sterile gowns and gloves aseptically c. Prepares surgical instruments, sponges, sutures and other supplies in functional arrangement d. Hands instruments, sponges, sutures and other needed materials according to surgeons preference e. Performs surgical count accurately Performs the functions of the circulating nurse a. Anticipates the needs of the surgical team b. Sets up the OR room and needed equipment c. Receives client for surgery and endorses client post-operatively d. Assist in skin preparation and draping of clients Administers medications and other health therapeutics safely MANAGEMENT OF RESOURCES AND ENVIRONMENT (MRE)

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1. Organizes workload to facilitate timely patient care 2. Utilizes adequate and appropriate resources to support the OR team 3. Ensures functionality of OR resources. 4. Maintains a safe environment at the OR by observing the principles of asepsis III. HEALTH EDUCATION (HE) 1. Implements appropriate health education activities to client based on needs assessment IV. LEGAL RESPONSIBILITIES 1. Adheres to legal and institutional protocols regarding informed consent. V. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. Respects the rights of the OR client 2. Accepts responsibility and accountability for own decisions and actions as an OR nurse. VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Performs OR functions according to professional standards. 2. Possesses positive attitude towards learning surgical and OR related knowledge and skills VII. QUALITY IMPROVEMENT (QI) 1. Participates in quality improvement activities related to the infection control and successful OR operations 2. Identifies and reports variances in sterility and other OR activities. VIII. RESEARCH (R) 1. Disseminates results of OR-related research findings to clinical group and other members of the OR Team as appropriate. IX. RECORDS MANAGEMENT (RM) 1. Maintain accurate and updated documentation of patient care. X. COMMUNICATION (Comm) 1. Establishes rapport with patients, significant others and members of the health team. 2. Uses appropriate information mechanisms to 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 health team. TOTAL

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When Graded RLEs were Performed (Specify Academic year and Semester); First Graded RLE Clinical Instructor :Academic Year ____________ 1st Sem. ____ 2nd Sem. ____ Summer _____ Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________

Second Graded RLE :Academic Year ____________ 1stSem ____ 2ndSem _____ Summer _____ Clinical Instructor Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________ Third Graded RLE Clinical Instructor :Academic Year ____________ 1st Sem. ____2nd Sem. _____ Summer ____ Name: _______________________ Signature ______________________ License Number: _______________ Validity: _______________________ ________________________________________ (Signature over Printed Name) Clinical Coordinator License Number _______________________ Validity ______________________________ : _______________________________________

Verified True and Correct:

Academic Year Graduated

_______________________________________ (Signature Over Printed Name) DEAN License Number: ______________________ Validity Date : _________________________