Ateneo de Zamboanga University College of Nursing Summary Performance Evaluation Achieving Intra-partal Care Competency In accordance with PRC

Board of Nursing Memorandum No. 01 Series 2009 Intrapartal Care (Assisted Case)

Name of Student: ___________________________________

Legend: (Rating Criteria) 4 Competent (Students performs efficiently in an effective and efficient manner) 3 Progress Acceptable (performance is usually effective and efficient but not always) 2 Needs Improvement (progress in performance is too slow to judge satisfactorily; task performance is not most of the time) 1 Progress Unacceptable (no progress in performance has been demonstrated, and or performance is consistently ineffective and inefficient) 1st Case 2nd Cas e 3rd Cas e Averag e Rating

INTRAPARTAL CARE COMPETENCIES I. Safe and Quality Nursing Care 1. Obtain Obstetric history, including parity, gravid Score, LMP, EDC, AOG, BOW, onset of true labor. 2. Checks maternal 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 such as: Frequency Duration Intensity Interval 7. Observes for the timely rupture of membranes Performs Functions During Actual Labor 8. Transports clients safely while providing privacy. 9. Places mother on lithotomy position properly. 10. Performs perineal care correctly. 11. Performs proper hand scrub. 12. Wear gowns and gloves according to hospital policy. 13. Performs proper Ritgens Maneuver safely.

14. Coaches mother on proper breathing and pushing techniques.

INTRAPARTAL CARE COMPETENCIES 15. Delivers baby and placenta carefully. Checks and manages cord coil correctly. Note the gender and time of delivery of the baby. Clamps and cuts the cord correctly. Identify signs of placental separation Note the delivery of the placenta 16. Assess amount of blood loss ( Normal: <500cc) 17. Employs interventions to achieve and maintain well contracted uterus to prevent or control hemorrhage. Uterine massage Correct administration of oxytocin 18. Assesses for presence and degree of laceration. 19. Assist in episiorrhaphy or repair of lacerations as necessary. 20. Checks size, consistency and location of uterus. 21. Performs perineal care and applies pad correctly. 22. Provides emotional support to patient throughout labor and delivery. 23. Evaluates patients condition and records pertinent data. 24. Prepare patient for transfer to recovery room/ward. II. Management Of Resources, Environment, And Equipment

1st Case

2nd Cas e

3rd Cas e

Averag e Rating

25. Prepares delivery room, instruments and equipment needed. Sterile drape Sterile instruments and equipment [Forceps, scissors, gauze, suture, needle holder, catheter (optional)] Kelly pad Disinfectant 26. Performs sterilization procedures. 27. Maintains adequacy of supplies, as the delivery progresses. 28. Maintains orderliness of the sterile table and mayostand 29. Observes precautionary measures related to use of electrical equipment. 30. Ensures a quiet environment. 31. Performs aftercare of the materials, instruments and equipment used. 32. Ensures proper disposal of hospital waste including blood and other body fluids. III. Health Education

33. Demonstrate to client on breathing/bearing down technique. 34. Demonstrates proper latch-on breast feeding technique. INTRAPARTAL CARE COMPETENCIES 35. Provides discharge instructions as to the feeding, bathing, take home medications care of episiotomy, appointment dates for post-natal visit. 36. Responds to inquiries of clients and relatives regarding expectations. IV. Legal Responsibility 37. Reports accurately and honestly the gender, time of delivery of the baby and the placenta. 38. Ensures proper identification of the mother and the newborn. 39. Documents all pertinent data completely and correctly. V. Ethico-Moral Responsibility 40. Respect the religious, cultural and ethnic practices of the family of the patient in labor and delivery. 41. Ensures privacy and confidentiality. VI. Personal and Professional Development 42. Accepts criticisms and recommendations. 43. Performs functions according to standards. 44. Courteous and works actively with the DR staff, Clinical Instructor, co- student nurses and members of the health team. 45. Prompt in reporting to RLE/duty. 46. Prompt in submitting requirements. VII. Quality Improvement 47. Identifies deviation of practice from the standards. 48. Participates in audit practices in the delivery room or lying-in. VIII. Research 1st Case 2nd Cas e 3rd Cas e Averag e Rating

49. Identifies researchable problems related to intrapartalnursing. 50. Utilizes relevant research findings related to intra-partal nursing. 51. Shares a relevant research findings from Journal readings IX. Records Management 52. Maintains organized system of filing and keeping records of the client.

X. Communication 53. Communicates therapeutically with patient and their significant others. INTRAPARTAL CARE COMPETENCIES 54. Utilizes proper channel of communication XI. Collaboration And Teamwork 55. Functions effectively as a team member in the delivery room /lying-in TOTAL SCORE: 220 1st Case 2nd Cas e 3rd Cas e Averag e Rating

Certified True and Correct:

_______________________________________ (Signature over Printed Name) INTRAPARTAL CASE No.1 ___________________________ Clinical Instructor PRC License No. ___________ Valid until: _______________ INTRAPARTAL CASE No. 2 INTRAPARTAL CASE No. 3 ___________________________ Clinical Instructor PRC License No. ___________ Valid until: _______________ ___________________________ Clinical Instructor PRC License No. ___________ Valid until: _______________

Noted By: __________________________________ BSNursing Level Coordinator License No. _______________ Valid Until: _______________

Ateneo de Zamboanga University College of Nursing Summary Performance Evaluation Achieving Intra-partal Care Competency In accordance with PRC Board of Nursing Memorandum No. 01 Series 2009 Intrapartal Care (Assisted Case)

Name of Student: ___________________________________

Legend: (Rating Criteria) 4 Competent (Students performs efficiently in an effective and efficient manner) 3 Progress Acceptable (performance is usually effective and efficient but not always) 2 Needs Improvement (progress in performance is too slow to judge satisfactorily; task performance is not most of the time) 1 Progress Unacceptable (no progress in performance has been demonstrated, and or performance is consistently ineffective and inefficient) 4th Case 5th Case Avera ge Ratin g

INTRAPARTAL CARE COMPETENCIES I. Safe and Quality Nursing Care

1. Obtain Obstetric history, including parity, gravid Score, LMP, EDC, AOG, BOW, onset of true labor. 2. Checks maternal 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 such as: Frequency Duration Intensity Interval 7. Observes for the timely rupture of membranes Performs Functions During Actual Labor 8. Transports clients safely while providing privacy. 9. Places mother on lithotomy position properly. 10. Performs perineal care correctly. 11. Performs proper hand scrub. 12. Wear gowns and gloves according to hospital policy. 13. Performs proper Ritgens Maneuver safely.

14. Coaches mother on proper breathing and pushing techniques.

INTRAPARTAL CARE COMPETENCIES 15. Delivers baby and placenta carefully. Checks and manages cord coil correctly. Note the gender and time of delivery of the baby. Clamps and cuts the cord correctly. Identify signs of placental separation Note the delivery of the placenta 16. Assess amount of blood loss ( Normal: <500cc) 17. Employs interventions to achieve and maintain well contracted uterus to prevent or control hemorrhage. Uterine massage Correct administration of oxytocin 18. Assesses for presence and degree of laceration. 19. Assist in episiorrhaphy or repair of lacerations as necessary. 20. Checks size, consistency and location of uterus. 21. Performs perineal care and applies pad correctly. 22. Provides emotional support to patient throughout labor and delivery. 23. Evaluates patients condition and records pertinent data. 24. Prepare patient for transfer to recovery room/ward. II. Management Of Resources, Environment, And Equipment

4th Case

5th Case

Avera ge Ratin g

25. Prepares delivery room, instruments and equipment needed. Sterile drape Sterile instruments and equipment [Forceps, scissors, gauze, suture, needle holder, catheter (optional)] Kelly pad Disinfectant 26. Performs sterilization procedures. 27. Maintains adequacy of supplies, as the delivery progresses. 28. Maintains orderliness of the sterile table and mayostand 29. Observes precautionary measures related to use of electrical equipment. 30. Ensures a quiet environment. 31. Performs aftercare of the materials, instruments and equipment used. 32. Ensures proper disposal of hospital waste including blood and other body fluids. III. Health Education

33. Demonstrate to client on breathing/bearing down technique. 34. Demonstrates proper latch-on breast feeding technique. INTRAPARTAL CARE COMPETENCIES 35. Provides discharge instructions as to the feeding, bathing, take home medications care of episiotomy, appointment dates for post-natal visit. 36. Responds to inquiries of clients and relatives regarding expectations. IV. Legal Responsibility 37. Reports accurately and honestly the gender, time of delivery of the baby and the placenta. 38. Ensures proper identification of the mother and the newborn. 39. Documents all pertinent data completely and correctly. V. Ethico-Moral Responsibility 40. Respect the religious, cultural and ethnic practices of the family of the patient in labor and delivery. 41. Ensures privacy and confidentiality. VI. Personal and Professional Development 42. Accepts criticisms and recommendations. 43. Performs functions according to standards. 44. Courteous and works actively with the DR staff, Clinical Instructor, co- student nurses and members of the health team. 45. Prompt in reporting to RLE/duty. 46. Prompt in submitting requirements. VII. Quality Improvement 47. Identifies deviation of practice from the standards. 48. Participates in audit practices in the delivery room or lying-in. VIII. Research 4th Case 5th Case Avera ge Ratin g

49. Identifies researchable problems related to intrapartalnursing. 50. Utilizes relevant research findings related to intra-partal nursing. 51. Shares a relevant research findings from Journal readings IX. Records Management 52. Maintains organized system of filing and keeping records of the client.

X. Communication 53. Communicates therapeutically with patient and their significant others. INTRAPARTAL CARE COMPETENCIES 54. Utilizes proper channel of communication XI. Collaboration And Teamwork 55. Functions effectively as a team member in the delivery room /lying-in TOTAL SCORE: 220 4th Case 5th Case Avera ge Ratin g

Certified True and Correct:

_______________________________________ (Signature over Printed Name) INTRAPARTAL CASE No.4 ___________________________ Clinical Instructor PRC License No. ___________ Valid until: _______________ INTRAPARTAL CASE No. 5 ___________________________ Clinical Instructor PRC License No. ___________ Valid until: _______________

Noted By: __________________________________ BSNursing Level Coordinator License No. _______________ Valid Until: _______________