QF-SON-042

EMILIO AGUINALDO COLLEGE

1113-1117 San Marcelino St. Ermita Manila
School of Nursing

SUMMARY PERFORMANCE EVALUATION ACHIEVING

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

Name of Student: ____________________________

Signature over printed name

I. SAFE AND QUALITY NURSING CARE (SQC) Weight Self Score Remarks
Evaluation
Intra-Partal Care Competencies
1. Obtains obstetrical history including parity, gravida score, LMP, EDC, 4
AOG, BOW onset of true labor.
2. Checks 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 using partograph. 4
7. Ensure that the mother is in her position of choice during labor 2
8. Ask the mother if she wishes to eat/ drink or void. 2
9. Communicates with the mother-informs her progress of labor, gives 2
reassurance and encouragement.
10. Checks temperature in the DR area to be 25-28C;eliminates air draft 4
Performs functions during actual labor
1. Transports clients safely while providing privacy. 1
2. Ensures that the mother is comfortable in the semi-upright position 2
3. Removes all the jewelry and washes hands thoroughly observing the 4
WHO 1-2-3-4-5 procedure
4. Performs perineal care using sterile technique correctly 2
5. Washes hands 1
6. Wears gown and gloves according to hospital policy. 1
7. Encourages mother to push as desired 2
8. Drapes the clean, dry linen over the mother’s abdomen or arms in 2
preparation for drying the baby
9. Performs Ritgen’s maneuver safely and controlled delivery the baby’s 2
head
10. Calls-out time of birth and sex of the baby 2
11. Informs the mother of the outcome 1
12. Excludes a 2nd baby by palpating the abdomen in preparation for giving 2
the oxytocin.
13. Gives 10 units of oxytocin intramuscularly within 1 minute after baby’s 4
birth.
14. Performs the remaining steps of the AMSTL:
 Checks for strong uterine contraction then applies controlled 1
cord traction and counter traction on the uterus, continuing
until placenta is delivered.
 Massage the uterus until it is firm 1
 Checks the characteristics/completeness of the placenta 1
15. Inspect the lower vagina and perineum for lacerations/tears and assist in 2
the repair (episiorraphy) as necessary.
16. Cleans the mother, flushes the perineum and applies perineal 2
pad/napkin/cloth
17. Dispose the placenta in leak-proof container or plastic bag 1
18. Decontaminates instruments for 10 minutes before cleaning 1
19. Advise the mother to maintain skin to skin contact with the baby. Baby 4
should be prone on the mother’s chest or between the breast with the
head turned to one side.
20. Advise mother to observes for feeding cues 2
21. Supports mother, instruct her on positioning and attachment 2
22. Waits for full breastfeeding to be completed 1
23. Advise the mother about the optional/delayed bathing of the baby 1
24. Advise the mother to do breastfeeding per demand 1
25. In the first hour: checks mother’s vital signs and massage the uterus 4
every 15 minutes
26. In the second hour: checks mother-baby dyad every 30 minutes to 1 hr. 2
27. Evaluates patient’s condition and records pertinent data accordingly. 4
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28. Prepares patient for transfer to recovery room/ward. 1
Newborn Competencies
1. Thoroughly dries the baby at leaser 30 seconds while performing a quick 4
check for breathing.
2. Removes the wet cloth
3. Places baby in skin to skin contact on the mother’s abdomen or chest 4
4. Cover the baby with the dry cloth and the baby’s head with the bonnet 2
5. Performs properly-timed cord clamping
 Palpates umbilical cord to check pulsation 1
 After pulsations stop, clamp the cord using plastic clamp or cord tie 1
2 cm from the base
 Places the instrument clamp 5cm from the base or 3cm from the 1
plastic clamp.
 Cut the cord near the plastic clamp 1
6. Checks baby’s color and breathing. May perform and interpret APGAR 2
scoring.
7. Maintains the baby in a skin to skin contact. Baby should be prone on the 4
mother’s chest or between breasts with the head turned to one side
8. Observes for breastfeeding cues 2
9. Waits for full breastfeeding to be completed 1
10. Administer eye ointment. (CREDE’s Prophylaxis) 1
11. Do thorough physical examination and anthropometric measurement 4
12 Administer injections:
 Vitamin K (1 mg/IM) into the lateral anterior thigh or vastus 1
lateralis,left leg.
 Hepatitis B on the right leg. 1
 BCG intradermal on either arm 1
13.In the first hour: checks baby’s breathing and color every 15 minutes 2
14. In the 2nd hour: checks the mother-baby dyad every 30 minutes to 1 hour 1
15. Records pertinent observations and nursing care done. 1
16. Reports any signs of deviation/abnormality to the pediatrician. 1
II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE)
Intra-Partal Care Competencies
1. Prepares room, instruments and equipment needed.
 Sterile drape
 Clear, clean newborn resuscitation area. Check the equipments if 1
clean, functional and within easy reach 1
 Arrange materials/supplies in a linear sequence: gloves, dry linen,
cloth/napkin( for Ritgens maneuver), bonnet, oxytocin injection, 2
plastic clamp, instrument clamp,scissors,2 kidney basins
2. Performs sterilization procedure. 1
3. Maintains adequacy of supplies as the delivery progresses. 1
4. Maintains orderliness of the sterile table. 1
5. Observes precautionary measures related to use of electrical equipment. 1
6. Ensures a quiet and draft free 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
Newborn Competencies
10. Prepares room, instruments and equipment needed.
 Clear, clean Newborn resuscitation area. Check the equipments if
clean, functional and within easy reach
 (Checks materials/supplies in a linear sequence) 1
 In a separate sequence to be used after the 1st full breast feeding:
prepares eye ointment, stethoscope, tape measure and others to be
used in anthropometric measurement ,injections (Vit.K, Hepatitis B 2
& BCG vaccines),cotton balls, forceps, etc.
11.Ensures use of sterile equipment during immediate care of the newborn 1
12.Maintain adequacy of supplies as newborn care is rendered 1
13Maintain adequacy of supplies as newborn care is rendered 1
14. Observes precautionary measures related to use of electrical equipment. 1
15. Ensures a warm and quiet environment. Maintains temperature at 25-28C 2
16. Uses supplies diligently. 1
17.Ensures proper disposal of hospital waste 1
III. HEALTH EDUCATION (HE)
1. Teaches client on basic preparation during labor and deliver 1
(can be done in the labor room).
2. Coaches client on breathing /bearing down technique. 2
3. Demonstrates proper “latch-on” breast feeding technique 1
(done post-partum period).
4. Gives instructions to parents regarding infant care before discharge 1
(done 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).
Newborn Competencies
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6. Provides instructions to the mother on daily cord care and prevention of 1
cord infection
7. Provides discharge instructions to the mother on when to expect cord to 1
fall off or to report signs of cord infection.
8. Provides information regarding newborn screening, immunization, 2
feeding, etc
9. 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 any deviations/abnormal findings and nursing 1
intervention rendered.
3. Reports accurately and honestly the gender, time of delivery of the baby 2
and placenta.
4. Ensures proper identification of the mother and newborn. 2
5. Identifies newborn by comparing ID band with data in the chart 2
6. Performs foot printing according to hospital policy 1
7. Ensures that birth certificate and other civil registration forms are 2
accomplished/filled out according to institutional policy.
8. Documents all pertinent data correctly and completely. 1
V. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, cultural 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. Updates oneself with the latest trends and development in labor and 1
delivery
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)
1. Identifies researchable problems related to labor and delivery/immediate 2
care of the newborn
2. Utilize findings of research studies in intra-partal care/ immediate care of 2
the newborn
IX RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about client. 1
2. Maintains an organized system of filing and keeping records of the 1
client.
X. COMMUNICATION (Comm)
1. Utilizes appropriately all forms of communication; verbal, non-verbal, 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 a 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 team 1
and family members.
TOTAL SCORE: 188
Grading System

Terminal Evaluation 25%

Requirements 55%

Obstetric Assessment 20%

Newborn Assessment 15%
Drug Study 10%
Journal 10%
Attitude/Paraphernalia’s 10%
Evaluation Exam 10%
__________
TOTAL 100%

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TARDINESS ABSENCES
DATE NUMBER OF MINUTES DATE REMARKS

Remarks/Comment:
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EVALUATED BY:

_______________________________________ ___________________________________
Clinical Instructor’s Signature Student’s Signature

EMILIO AGUINALDO COLLEGE

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