SUMMARY PERFORMANCE EVALUATION ACHIEVING

INTRA-PARTAL CARE COMPETENCY

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

Signature over Printed Name of Student:

INTRAPARTAL COMPETENCIES DESIRED ACTUAL

RATING RATING
I.SAFE AND QUALITY NURSING CARE (SQC)
1. Obtains obstetrical history including parity, gravid a score, LMP, EDC, 4
AOG, BOW onset
2. Check vital signs. 1
3. Conducts physical examination. 2
4. Performs Leopold’s maneuver. 2
5. Checks Fetal Heart Rate and Fundic height. 2
6. Monitor progress of labor/uterine contractions as to:
6.1 Frequency 1
6.2 Duration 1
6.3 Intensity 1
6.4 Interval 1
7. Observes for the timely rupture of membrane. 1
8. Coaches mother on process of labor. 2
PERFORMS FUNCTIONS DURING ACTUAL LABOR
1. Transports clients safely while providing privacy. 1
2. Places mother in lithotomy position. 1
3. Performs perineal care using sterile technique correctly. 1
4. Performs proper hand scrub. 1
5. Wears 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 1
Clamps and cuts the cord correctly 1
Identify signs of placental separation 1
Checks the characteristic/ completeness of the placenta 1
9. Assesses amount of blood loss (Normal: <500 cc) 2
10. Employs interventions to achieve and maintain a well contracted uterus to
prevent/ control hemorrhage. 1
10.1 Uterine massage 1
10.2 Correct administration of oxytocin 1
10.3 Cold compress
11. Assesses presence and degree of laceration. 1
`12. Assists in episiorraphy. 1
13. Checks size, consistency and location of uterus. 1
INTRAPARTAL COMPETENCIES
14. Performs perineal care and applies pad correctly. 1
15. Provides emotional support to the mother throughout labor and delivery. 1
16. Evaluates patient’s condition and records pertinent data accordingly. 2
17. Prepares patient for transfer to recovery room/ ward. 1
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE)
1. Prepares room, instruments and equipment needed.
1.1 Sterile drape 1
1.2 Sterile instruments and equipment [Forceps, scissors, bulb 1
syringe, gauze, suture, needle holder, catheter(optional)]
1.3vKelly pad 1
1.4 Disinfectant 1
2. Performs sterilization procedure. 1
3. Maintains adequacy of supplies as the delivery progresses. 1
4. Maintain orderliness of the sterile table 1
5. Observes precautionary measures related to use of electrical equipment 1
6. Ensures a quite environment. 1
7. Uses supplies diligently. 1
8. Performs after care of the materials and equipments used 1
9. Ensures proper disposal of hospital waste including blood and other fluids 1
III. HEALTH EDUCATION (HE)
1. Teaches client on basic preparation during labor and deliver (can be done in 1
the labor room)
2. Coaches’ client on breathing/bearing down technique. 2
3. Demonstrates proper “latch-on” breast feeding technique (done post-partum 1
period).
4. Gives instructions to parents regarding infant care before discharge (done 1
post-partum period).
5. Provides discharge instructions as to feeding, bathing, administration of 1
ordered medications, appointment dates for post natal and well baby check up
(done post-partum period.)
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 of delivery of the baby and 2
placenta.
3. Ensures proper identification of the mother and newborn. 2
4. Documents all pertinent data correctly and completely. 1
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, culture and ethnic practices of the family of the 1
woman in labor and delivery.
2. Promotes emotional security by supporting needs. 1
3. Ensures privacy and confidentiality. 1
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Update oneself with the latest trends and development in labor and delivery. 1
INTRAPARTAL COMPETENCIES
2. Projects a professional image of a delivery room nurse. 1
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards. 1
VII. QUALITY IMPROVEMENT (QI) (preferably done during post conferences)
1. Identifies deviation of practice from the standards. 1
2. Participates in audit practices in the delivery room/lying in. 1
3. Recommends corrective and preventive measures for the identified 1
deviations.
VIII. RESEARCH (R) (preferably done during post conferences)
1. Identifies researchable problems related to labor and delivery. 2
2. Utilize findings of research studies in intra-partal care. 2
IX. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about client. 1
2. 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-vervabl, 1
electronic.
2. Inform client’s significant others of the progress of labor and delivery. 1
3. Listens attentively to clients and families queries and requests. 1
XI. COLLABORATION AND TEAMWORK (CTW)
1. Functions effectively as team player in the delivery room/lying in. 1
2. Communicates the progress of labor/delivery to significant others. 1
3. Establishes collaborative relationship with members of the health and 1
family members.
TOTAL SCORE 90
Certified True and Correct:
 ZHERROUINE RHEDD V. MALAVEGA
(Signature over Printed Name)

___________________________________
Clinical Instructor
License Number: ________________
PRC Card-Validity Date:

MA. REINA ROSE D. GULMATICO, RN, MSN

Clinical Coordinator
License Number: 0357992
PRC Card-Validity Date: November 14, 2020

LEONORA R. CONCEPCION, RN, MAN, EdD

DEAN
License Number: 0287764 Academic Year Graduated
PRC Card- Validity Date: June 15, 2021
 SUMMARY PERFORMANCE EVALUATION ACHIEVING
IMMEDIATE CARE OF THE NEWBORN COMPETENCY

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

Signature over Printed Name of Student: ZHERROUINE RHEDD V. MALAVEGA

DESIRED ACTUAL
NEWBORN COMPETENCIES RATING RATING
I.SAFE AND QUALITY NURSING CARE (SQC)
1. Establishes and maintains patent airway. 3
2. Puts the newborn in Trendelenburg position. 1
3. Suctions mouth and nose of the newborn gently. 2
4. Dries newborn wraps warmly.
Places under droplight as needed 1
5. Performs and interprets APGAR scoring correctly.
Immediately after delivery 2
After 5 minutes 2
6. Ensures proper identification of newborn (name tag: name of mother, date
2
and time of delivery, gender and name of attending physician).
7. Performs physical assessment including anthropometric measurements
4
including weight, height, head, chest, abdominal circumference.
8. Takes vital signs (temperature per rectum to check patency) 1
9. Gives oil/ water and soap bath according to institutional policy. 1
10. Latches newborn to the mother’s breast immediately after birth. 1
11. Applies CREDE’s prophylaxis on the eyes. 1
12. Performs cord dressing aseptically.
Disinfects area properly according to hospital policy. 1
Clamps and cuts cord 1 inch from the abdomen. 1
Check for the presence 2 arteries and 1 vein. 1
Dresses cord aseptically according hospital policy. 1
13. Administers Vitamin K (1 mg/M) in to the lateral anterior thigh or vastus
laterialis. 1
14. Keeps baby wrapped warmly under floor lamp or beside mother according to
1
institutional policy until discharge.
15. Records pertinent observations and care done. 1
16. Reports any signs of deviation/abnormality to the pediatrician. 1
II.MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE)
1. Prepares instrument and equipment needed.
Suction bulb, cord clamp, gauze, cotton balls, disinfectant, blanket, 4
droplight, Vitamin K, antimicrobial ophthalmic ointment.
2. Ensures use of sterile equipment during immediate care of the newborn. 1
3. Maintain adequacy of supplies as newborn care is rendered. 1
4. Maintain orderliness of the working area. 1
5. Observes precautionary measures related to use of electrical equipment. 1
6. Ensures a warm and quite environment. 1
7. Uses supplies diligently. 1
8. Ensures proper disposal of hospital waste. 1
III. HEALTH EDUCATION (HE)
1. Provides instruction to the mother on daily cord care and prevention of cord
infection. 2
2. Provides discharge instruction to the mother on when to expect cord to fall
1
off or to report signs of cord infection.
3. Provides information regarding newborn screening, immunization, feeding,
etc. 2
4. Response to questions of mother and relatives regarding expectations. 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. 1
3. Reports accurately any deviations/abnormal findings and nursing
1
interventions rendered.
4. Ensures that birth certificate and other civil registration forms are
2
accomplished/ filled out according to institutional policy.
5. Performs foot printing according to hospital policy. 1
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, culture and ethnic practices of the family of the
1
newborn.
2. Maintains privacy and confidentiality of findings of assessments. 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. 1
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards. 1
VII. QUALITY IMPROVEMENT (QI)
1. Identifies deviation of practice from the standards. 1
2. Participates (whenever possible) in audit practices in the nursery. 1
3. Recommends corrective and preventive measures for the identified
1
deviations.
VIII. RESEARCH (R)
1. Identifies researchable problems related to immediate care of newborn. 2
2. Utilizes findings of research studies in the immediate care of the newborn. 2
IX. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about the newborn. 1
2. Maintains an organized system of filing and record keeping. 1
X. COMMUNICATION (Comm)
1. Utilizes appropriately all forms of communication; verbal, non-verbal,
1
electronic.
2. Maintains an open line of communication with the mother and other family
1
members.
3. Informs mother of relevant information about the newborn. 1
4. 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. 1
2. Communicates findings of assessment to all concerned.
1
3. Establishes a collaborative relationship with members of the health team
1
and family of the newborn.
TOTAL SCORE: 75

Certified True and Correct:

 ZHERROUINE RHEDD V. MALAVEGA_____
(Signature over Printed Name)

___________________________________
Clinical Instructor
License Number: ________________
PRC Card-Validity Date:

MA. REINA ROSE D. GULMATICO, RN, MSN

Clinical Coordinator
License Number: 0357992
PRC Card-Validity Date: November 14, 2020

LEONORA R. CONCEPCION, RN, MAN, EdD

DEAN
License Number: 0287764 Academic Year Graduated
PRC Card- Validity Date: June 15, 2021
 SUMMARY PERFORMANCE EVALUATION ACHIEVING
INTRA-OPERATIVE CARE COMPETENCY

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

Signature over Printed Name of Student: ZHERROUINE RHEDD V. MALAVEGA

DESIRE 1 st 2nd 3 rd AVERAGE

INTRA-OPERATIVE CARE D RLE RLE RLE RATING
COMPETENCIES RATING

I. SAFE AND QUALITY NURSING CARE(SQC)

1. Utilizes the nursing process in the care of OR 4
client.
a. Obtains comprehensive client’s information
by checking complete accomplishment of the
preoperative checklist/client’s chart.
b. Identifies priority needs of the client at the 4
Operating Room.
c. Provides needed nursing interventions based 4
on identified needs.
d. Monitors client’s responses to surgery. 2
2. Promotes safety and comfort of patients inside 2
the OR.
3. Performs the functions of the scrub nurse 4
a. Performs surgical scrub correctly
b. Wears sterile gowns and gloves aseptically. 2
c. Prepares surgical instruments, sponges, 2
sutures and other supplies in functional
arrangement.
d. Hands instruments, sponges, sutures and other 2
needed materials according to surgeon’s
preference.
e. Performs surgical count accurately. 2
4. Performs the functions of the circulating nurse. 2
a. Anticipates the needs of the surgical team.
b. Sets up the OR room and needed equipment. 2
c. Receives client for surgery/ endorses client 2
post-operatively.
d. Assists in skin preparation and draping of 2
client.
e. Administers medications and other health 2
therapeutics safely.
II. MANAGEMENT OF RESOURCES AND ENVIRONMENT(MRE)
1. Organizes work load to facilitate timely patient 4
care.
2. Utilizes adequate and appropriate resources to 2
support the OR team.
3. Ensures functionality of OR resources. 2
4. Maintains a safe environment at the OR by 2
observing the principles of asepsis.
III. HEALTH EDUCATION (HE)
Implements appropriate health education activities 2
to client based on needs assessment.
IV. LEGAL RESPONSIBILITIES (LR)
1. Adheres to legal and institutional protocols 2
regarding informed consent.
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
 1. Respects the rights of the or client 2
2. Accepts responsibility and accountability for 2
own decision as an OR nurse.
VI. PERSONAL AND PROFESIONAL DEVELOPMENT (PPD)
1. Performs OR functions according to professional 4
standards.
2. Possesses positive attitude towards learning 2
surgical and OR-related knowledge and skills.
VII. QUALITY IMPROVEMENT (QI)
1. Participates in quality improvement activities 2
related to infection control and successful OR
operations.
2. Identifies and reports variances in sterility and 2
other OR activities.
VIII. RESEARCH (R)
1. Disseminates results of OR-related research 2
findings to clinical group and other members of the
OR team as appropriate.
IX. RECORDS MANAGEMENT (RM)
1. Maintain accurate and updated documentation of 2
patient care.
X. COMMUNICATION (Comm)
1. Establishes rapport with patients, significant 1
others and members of the health team.
2. Uses appropriate information mechanisms to 2
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 2
the health team.
TOTAL SCORE 75
Certified True and Correct:

_ ZHERROUINE RHEDD V. MALAVEGA_____

(Signature over Printed Name)

___________________________________
Clinical Instructor
License Number: ________________
PRC Card-Validity Date:

MA. REINA ROSE D. GULMATICO, RN, MSN

Clinical Coordinator
License Number: 0357992
PRC Card-Validity Date: November 14, 2020

LEONORA R. CONCEPCION, RN, MAN, EdD

DEAN
License Number: 0287764 Academic Year Graduated
PRC Card- Validity Date: June 15, 2021