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Pines City CollegesCollege of nursing

Magsaysay Ave. Baguio City 2600Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208

www.pcc.edu.ph

SUMMARY PERFORMANCE EVALUATION ACHIEVING

INTRA-PARTAL CARE COMPETENCYIn Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Signature over Printed Name of Student: ___________________________________________ Academic Year Graduated : ________________

INTRAPARTAL COMPETENCIES DESIREDRATING

1 s RLE

2nd RLE

3 rd RLE

AVERAGERATING

I. SAFE AND QUALITY NURSING CARE (SQC)1. Obtains obstetrical history including parity, gravida score,

LMP, EDC, AOG, BOW onset of true labor.4

2. Checks vital signs. 13. Conducts physical examination. 24. Performs Leopolds maneuver. 25. Checks Fetal Heart Rate and Fundic height. 26. Monitor progress of labor/ uterine contractions as to:

Frequency Duration Intensity Interval

1111

7. Observes for the timely rupture of membrane. 18. Coaches mother on process of labor. 2

PERFORMS FUNCTIONS DURING ACTUAL LABOR1. Transports clients safely while providing privacy. 12. Places mother in lithotomy position.

13. Performs perineal care using sterile technique correctly. 14. Performs proper hand scrub. 15. Wears gown and gloves according to hospital policy. 16. Performs Ritgens maneuver safely. 27. Coaches mother on breathing and pushing techniques. 18. Delivers baby and placenta carefully.

Checks and manages cord recoil correctly Clamps and cuts the cord correctly Identify signs of placental separation Checks the characteristic/ completeness of the placenta

1111

9. Assesses amount of blood loss (Normal:


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INTRAPARTAL COMPETENCIES 14. Performs perineal care and applies pad correctly. 115. Provides emotional support to the mother throughout labor

and delivery.1

16. Evaluates patients condition and records pertinent dataaccordingly.

2

17. Prepares patient for transfer to recovery room/ ward. 1II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE) 1. Prepares room, instruments and equipment needed.

Sterile drape Sterile instruments and equipment [Forceps, scissors, bulbsyringe, gauze, suture, needle holder, catheter (optional)]

Kelly pad Disinfectant

11

11

2. Performs sterilization procedure. 13. Maintains adequacy of supplies as the delivery progresses. 14. Maintains orderliness of the sterile table. 15. Observes precautionary measures related to use of

electrical equipment.1

6. Ensures a quiet environment. 17. Uses supplies diligently. 18. Performs after care of the materials and equipments used. 1

9. Ensures proper disposal of hospital waste including bloodand other fluids. 1

III. HEALTH EDUCATION (HE) 1. Teaches client on basic preparation during labor and

deliver1

2. Coaches client on breathing/ bearing down technique. 23. Demonstrates proper latch -on breast feeding technique. 14. Gives instructions to parents regarding infant care before

discharge.1

5. Provides discharge instructions as to feeding, bathing,administration of ordered medications, appointment datesfor post natal and well baby check up.

1

6. Responds to questions of clients and relatives regarding

expectations.

1

IV. LEGAL RESPONSIBILITIES (LR)1. Secures informed consent in all procedures related to labor

and delivery.1

2. Reports accurately and honestly the gender, time ofdelivery of the baby and placenta.

2

3. Ensures proper identification of the mother and newborn. 24. Documents all pertinent data correctly and completely. 1V. ETHICO-MORAL RESPONSIBILITIES (EMR)1. Respects the religious, cultural and ethnic practices of the

family of the woman in labor and delivery.1

2. Promotes emotional security by supporting needs. 13. Ensures privacy and confidentiality. 1

VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)1. Updates oneself with the latest trends and development in

labor and delivery.1

INTRAPARTAL COMPETENCIES 2. Projects a professional image of a delivery room nurse. 13. Accepts criticisms and recommendations. 14. Performs functions according to standards. 1


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VII. QUALITY IMPROVEMENT (QI)1. Identifies deviation of practice from the standards. 12. Participates in audit practices in the delivery room/lying in. 13. Recommends corrective and preventive measures for the

identified deviations.1

VIII. RESEARCH (R)1. Identifies researchable problems related to labor and

delivery.1

2. Initiates a research study on an identified researchable

problem.

1

3. Participates as a member of a research team in theconduction of a research study.

1

4. Utilize findings of research studies in intra-partal care. 1IX. RECORDS MANAGEMENT (RM) 1. Documents accurately relevant data about client. 12. Maintains an organized system of filing and keeping

records of the client.1

X. COMMUNICATION (Comm) 1. Utilizes appropriately all forms of communication; verbal,

non-verbal, electronic.1

2. Inform clients significant others of the progress of labor anddelivery.

1

3. Listens attentively to clients and families queries andrequests.

1

XI. COLLABORATION AND TEAMWORK (CTW) 1. Functions effectively as a team player in the delivery

room/lying in.1

2. Communicates the progress of labor/delivery to significantothers.

1

3. Establishes collaborative relationship with members of thehealth team and family members.

1

TOTAL SCORE: 90

When Graded RLEs were performed (Specify Academic Year and Semester):

First Graded RLE : Academic Year _____________ 1 st Sem.__ 2 nd Sem.__ Summer__Clinical Instructor : Name ________________________ Signature __________________

License Number: ______________ Validity: ___________________Second Graded RLE : Academic Year ___________ 1 st Sem.__ 2 nd Sem.__ Summer__Clinical Instructor : Name ________________________ Signature __________________

License Number: ______________ Validity: ___________________Third Graded RLE : Academic Year ___________ 1 st Sem.__ 2 nd Sem.__ Summer__ Clinical Instructor : Name ________________________ Signature __________________

License Number: ______________ Validity: ___________________

Verified True and Correct : LYNN B. LABAN License Number: 0153941(Signature over Printed Name) Clinical Coordinator Validity: February 22, 2014

JUANITA Y. NIALLA License Number: 0124322DEAN Validity Date : November 21, 2013

Signature over Printed Name


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www.pcc.edu.ph

PERFORMANCE EVALUATION ACHIEVING

IMMEDIATE CARE OF THE NEWBORN COMPETENCYIn Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Signature over Printed Name of Student: ___________________________________________ Academic Year Graduated : ________________

NEWBORN COMPETENCIES DESIREDRATING

1 s RLE

2nd RLE

3 rd RLE

AVERAGERATING

I. SAFE AND QUALITY NURSING CARE (SQC)1. Establishes and maintains patent airway. 32. Puts the newborn in Trendelenburg position. 13. Suctions mouth and nose of the newborn gently. 24. Dries newborn and wraps warmly.

Places under droplight as needed1

5. Performs and interprets APGAR scoring correctly. Immediately after delivery After 5 minutes

22

6. Ensures proper identification of newborn (name tag: nameof mother, date and time of delivery, gender and name ofattending physician).

2

7. Performs physical assessment. 28. Takes anthropometric measurements including weight,

height, head, chest, abdominal circumference.2

9. Takes vital signs (temperature per rectum to checkpatency)

1

10. Gives oil/ water and soap bath according to institutionalpolicy.

1

11. Latches newborn to the mothers breast immediately afterbirth.

1

12. Applies CREDEs prophylaxis on the eyes. 113. Performs cord dressing aseptically.

Disinfects area properly according to hospital policy Clamps and cuts cord 1 inch from the abdomen Checks for the presence of 2 arteries and 1 vein Dresses cord aseptically according hospital policy

1111

14. Administers Vitamin K (1 mg/M) into the lateral anteriorthigh or vastus lateralis.

1

15. Keeps baby wrapped warmly under floor lamp or besidemother according to institutional policy until discharge. 116. Records pertinent observations and nursing care done. 117. Reports any signs of deviation/abnormality to the

pediatrician.1


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II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE) 1. Prepares instrument and equipment needed

Suction bulb, cord clamp, gauze, cotton balls,disinfectant, blanket, droplight, Vitamin K, antimicrobialophthalmic ointment.

4

2. Ensures use of sterile equipment during immediate careof the newborn.

1

3. Maintain adequacy of supplies as newborn care isrendered

1

4. Maintains orderliness of the working area. 15. Observes precautionary measures related to use of

electrical equipment.1

6. Ensures a warm and quiet environment. 17. Uses supplies diligently. 18. Ensures proper disposal of hospital waste. 1

III. HEALTH EDUCATION (HE) 1. Provides instructions to the mother on daily cord care and

prevention of cord infection.2

2. Provides discharge instructions to the mother on when toexpect cord to fall off or to report signs of cord infection.

1

3. Provides information regarding newborn screening,immunization, feeding, etc.

2

4. Responds to questions of mother and relatives regardingexpectations. 1

IV. LEGAL RESPONSIBILITIES (LR) 1. Identifies newborn by comparing ID band with data in the

chart.2

2. Documents all pertinent data correctly and completely. 13. Reports accurately any deviations/abnormal findings and

nursing interventions rendered.1

4. Ensures that birth certificate and other civil registrationforms are accomplished/ filled out according toinstitutional policy.

2

5. Performs foot printing according to hospital policy. 1V. ETHICO-MORAL RESPONSIBILITIES (EMR)

1. Respects the religious, cultural and ethnic practices of thefamily of the newborn. 1

2. Maintains privacy and confidentiality of findings ofassessments.

1

VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Updates oneself with the latest trends and developments

in newborn care.1

2. Projects a professional image of the pediatric nurse. 13. Accepts criticisms and recommendations. 14. Performs functions according to standards. 1

VII. QUALITY IMPROVEMENT (QI) 1. Identifies deviation of practice from the standards. 12. Participates in audit practices in the nursery. 13. Recommends corrective and preventive measures for the

identified deviations.1

VIII. RESEARCH (R) 1. Identifies researchable problems related to immediate

care of newborn.1

2. Initiates a research study on an identified researchableproblem.

1

3. Participates as a member of a research team in theconduction of a research study.

1


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4. Utilizes findings of research studies in the immediate careof the newborn.

1

IX. RECORDS MANAGEMENT (RM) 1. Documents accurately relevant data about the newborn. 12. Maintains an organized system of filing and record

keeping.1

X. COMMUNICATION (Comm) 1. Utilizes appropriately all forms of communication; verbal,

non-verbal, electronic.1

2. Maintains an open line of communication with the motherand other family members.

1

3. Informs mother of relevant information about the newborn. 14. Listens attentively to queries and requests of mothers and

family members.1

XI. COLLABORATION AND TEAMWORK (CTM) 1. Functions effectively as a team player in the nursery. 12. Communicates findings of assessment to all concerned. 13. Establishes a collaborative relationship with members of

the health team and family of the newborn.1

TOTAL SCORE: 75

When Graded RLEs were performed (Specify Academic Year and Semester):





Verified True and Correct : LYNN B. LABAN License Number: 0153941

(Signature over Printed Name) Clinical Coordinator Validity: February 22, 2014




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www.pcc.edu.ph

SUMMARY PERFORMANCE EVALUATION ACHIEVINGINTRA-OPERATIVE CARE COMPETENCY

In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009 Signature over Printed Name of Student: ___________________________________________

Academic Year Graduated : ________________

INTRA-OPERATIVE CARE COMPETENCIES DESIREDRATING

1 st RLE

2n RLE

3 r RLE

AVERAGERATING

I. SAFE AND QUALITY NURSING CARE (SQC)1. Utilizes the nursing process in the care of OR

clienta. Obtains comprehensive clients information

by checking complete accomplishment ofthe preoperative checklist/clients chart

4

b. Identifies priority needs of the client at theOperating Room

4

c. Provides needed nursing interventionsbased on identified needs

4

d. Monitors clients responses to surgery 22. Promotes safety and comfort of patients inside

the OR2

3. Performs the functions of the scrub nursea. Performs surgical scrub correctly 4b. Wears sterile gowns and gloves aseptically 2c. Prepares surgical instruments, sponges,

sutures and other supplies in functionalarrangement

2

d. Hands instruments, sponges, sutures andother needed materials according tosurgeons preference

2

e. Performs surgical count accurately 24. Performs the functions of the circulating nurse

a. Anticipates the needs of the surgical team 2b. Sets up the OR room and needed

equipment2

c. Receives client for surgery / endorses clientpost operatively

2

d. Assists in skin preparation and draping ofclient

2

5. Administers medications and other

health therapeutics safely

2

II. MANAGEMENT OF RESOURCES AND ENVIRONMENT (MRE)1. Organizes work load to facilitate timely patient

Care4

2. Utilizes adequate and appropriate resources tosupport the OR team

2

3. Ensures functionality of OR resources 2

4. Maintains a safe environment at the OR byobserving the principles of asepsis

2
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III. HEALTH EDUCATION (HE)1. Implements appropriate health education

activities to client based on needs assessment2

IV. LEGAL RESPONSIBILITIES (LR)1. Adheres to legal and institutional protocols

regarding informed consent2

V. ETHICO-MORAL RESPONSIBILITIES (EMR)1. Respects the rights of the OR client 22. Accepts responsibility and accountability for own

decisions and actions as an OR nurse2

VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)1. Performs OR functions according to professional

standards4

2. Possesses positive attitude towards learningsurgical and OR-related knowledge and skills

2

VII. QUALITY IMPROVEMENT (QI)1. Participates in quality improvement activities

related to infection control and successful ORoperations

2

2. Identifies and reports variances in sterility andother OR activities

2

VIII. RESEARCH (R)1. Disseminates results of OR-related research

findings to clinical group and other members ofthe OR teamas appropriate

2

IX. RECORDS MANAGEMENT (RM)1. Maintain accurate and updated documentation of

patient care 2

X. COMMUNICATION (Comm)1. Establishes rapport with patients, significant

others and members of the health team1

2. Uses appropriate information mechanisms tofacilitate communication inside the OR and withother departments in the hospital

2

XI. COLLABORATION AND TEAMWORK (CTM)1. Collaborates plan of care with other members of

the health team2

TOTAL SCORE 75When Graded RLEs were performed (Specify Academic Year and Semester):





Verified True and Correct : LYNN B. LABAN License Number: 0153941(Signature over Printed Name) Clinical Coordinator Validity: February 22, 2014

