You are on page 1of 7

PAMANTASAN NG CABUYAO

Katapatan Homes, Banay-banay Cabuyao, Laguna

COLLEGE OF NURSING SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-OPERATIVE CARE COMPETENCY


Signature over Printed Name of Student: AIRYN M. CAON Desired Rating 1st 2nd 3rd RLE RLE RLE Average Rating

INTRA-OPERATIVE CARE COMPETENCIES I. SAFE AND QUALITY NURSING CARE (SQC) 1. Utilizes the nursing process in the care of OR client. a .Obtain comprehensive clients information by checking complete accomplishment of the preoperative checklist/ clients chart.

b. Identify priority needs of the client at the OR. 4 c. Provide needed nursing interventions based on identified needs. 4 d. Monitor clients responses to surgery. 2 2. Promote safety and comfort of patient inside the OR 2 3. Perform the function of the scrub nurse a. Perform surgical scrub correctly. 4 b. Wear sterile gown and gloves aseptically. 2 c. Prepare surgical instruments, sponges, sutures, and other supplies in functional arrangement. 2 d. Hand instruments, sponges, sutures, and other needed Materials according to surgeons preferences. 2 e. Perform surgical count accurately. 2 4. Perform the functions of the circulating nurse a. Anticipate the needs of the surgical team. 2 b. Set up the OR and needed equipment. 2 c. Receive client for surgery/endorse client postOperatively. 2 d. Assist in skin preparation and draping of client. 2 5. Administer medications and health therapeutics safety. 2 II. MANAGEMENT OF RESOURCES AND ENVIROMENT (MRE) 1. Organizes work load to facilitate timely patient care. 4 2. Utilizes adequate and appropriate resources to support The OR team. 2 3. Ensures functionality of OR Resources. 2 4. Maintain a safe environment at the OR by observing the principles 2 III. HEALTH EDUCATION (HE) 1. Implements appropriate health education activities to Client based on needs assessment. 2 IV- LEGAL RESPONSIBOLITIES ( LR ) 1. Adhere to legal and Institutional protocols regarding informed consent. 2 V. ETHICO-MORAL REPONSIBILITIES (EMR) 1. Respect the rights of the OR client 2 2. Accepts responsibility and accountability for own Decisions and actions as an OR nurse. 2 VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Perform OR functions according to professional standards. 4 2. Possesses positive attitude towards learning surgical and 2

OR related knowledge and skills. VII. QUALITY IMPROVEMENT(QI) 1. Participates in quality improvement activities related to Infection control and successful OR operations. 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. TOTAL SCORE
* CERTIFIED TRUE AND CORRECT (Signature over Printed Name)

2 2 1 75

Ma. Liza Remille B. Hernandez, RN, MAN Clinical Instructor License Number: 0217245 PRC Card Validity Date: 03-01-15

Yvette V. Agarao, RN, MAN Clinical Coordinator License Number: 0358494 PRC Card Validity Date: 08-20-13

Herman F. Zoleta, RN, MAN College Dean License Number: 0244486 PRC Card Validity Date: 11-11-12

2011- 2012 Academic Year Graduated

PAMANTASAN NG CABUYAO
Katapatan Homes, Banay-banay Cabuyao, Laguna

COLLEGE OF NURSING SUMMARY PERFORMANCE EVALUATION ACHIEVING IMMEDIATE CARE OF NEWBORN COMPETENCY

Signature over Printed Name of Student: AIRYN M. CAON NEWBORN COMPETENCIES I. SAFE AND QUALITY NURSING (SQC) 1. Establishes and maintain patent airway. 2. Puts the newborn in trendelenburg position 3. Suctions mouth and nose of the newborn gently as needed. 4. Dries newborn and wraps warmly. Places under droplight as needed. 5. Performs and interprets APGAR scoring correctly. Immediately after delivery. After 5minutes. 6. Ensures proper identification of newborn (name, tag; name of mother; date & time of delivery; gender and name of attending physician) 7. Performs physical assessment including anthropometric measurements Including weight, height, head, chest, abdominal circumference. 8. Take vital signs (temperature, per rectum to check patency 9. Gives oil/water bath according to institutional policy. 10. Latches newborn to the mothers breast immediately after birth. 11. Applies CREDEs prophylaxis on the eyes. 12. Performs cord dressing aseptically. Disinfects area properly according to hospital policy. Clamps and cuts cord 1inch from the abdomen. Checks for the presence of 2 arteries and 1 vein. Dresses cord aseptically according to hospital policy. DESIRED RATING 3 1 2 1 2 2 2 2 1 1 3 1 1 1 1 1 ACTUAL RATING

13. Administers Vitamin K (1mg/IM) into the lateral anterior thigh or vastus Lateralis. 1 14. Keeps baby wrapped warmly under floor lamp or beside mother according To institutional policy until discharge. 1 15. Records pertinent observations and nursing care code. 1 16. Reports any signs of deviation/abnormality to the pediatrician. 1 II. MANAGEMENT OF RESOURCES, ENVIROMENT AND EQUIPMENT (MREE) 1. Prepares instruments and equipment needed. Suction bulb, cord clamp, gauze, cotton balls, disinfectant, blanket, 4 Droplight, Vit. 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. Observe precautionary measures related to use of electrical equipment. 1 6. Ensures a warm and quiet environment. 1 7. Uses supplies diligently. 1 8. 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 to expect cord to fall Of or to report signs of cord infection. 1 3. Provides information regarding newborn screening, immunization, feeding, 2 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 and deviations/abnormal findings and nursing Intervention rendered. 4. Ensures that birth certificate and other civil registration forms are Accomplished/filed out according to institutional policy. 5. Performs foot printing according to hospital policy. V. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. Respect the religious, cultural and ethnic practices of the family of newborn. 2. Maintain privacy and confidentiality of findings of assessments. VI. PERSONAL AND PROFESSIONAL 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 criticism and recommendations. 4. Performs functions according to standards. VII. QUALITY IMPROVEMENT (QI) 1. Identifies deviation and practice from the standards. 2. Participates (whenever possible) 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. Utilizes findings of research studies in the immediate care of the newborn. IX. RECORDS MANAGEMENT 1. Documents accurately relevant data about the newborn. 2. Maintains an organized system of filling and record keeping. X. COMMUNICATION (Comm.) 1. Utilizes appropriately all forms of communication; verbal, non-verbal, Electronic. 2. Maintain an open line of communication with the mother and other family Members. 3. Inform mother of relevant information about the newborn. 4. Listen attentively to queries and request of mother and family members. XI. COLLABORATION AND TEAMWORK (CTM) 1. Function effectively as a team player in the nursery. 2. Communicates findings of assessment to all concerned. 3. Establishes a collaborative relationship with members of the health team and Family of the newborn. TOTAL SCORE
CERTIFIED TRUE AND CORRECT (Signature over Printed Name)

1 2 1 1 2 1 1 1 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 75

Ms. Minerva A. Sanchez, RN, RM, MAN Clinical Instructor License Number: 0184253 PRC Card Validity Date: 09-15-14

Yvette V. Agarao, RN, MAN Clinical Coordinator License Number: 0358494 PRC Card Validity Date: 08-20-13

Herman F. Zoleta, RN, MAN


College Dean License Number: 0244486 PRC Card Validity Date:

2011-2012 Academic Year Graduated

11-11-12

PAMANTASAN NG CABUYAO
Katapatan Homes,Banay-banay Cabuyao,Laguna

College OF NURSING SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-PARTAL CARE COMPETENCY


Signature over Printed Name of Student: AIRYN M. CAON DESIRED RATING ACTUAL RATING

INTRA-PARTAL COMPETENCIES

I. SAFE AND QUALITY NURSING CARE (SQC) 1. Obtains obstetrical history including parity, gravida score, LMP, EDC, AOG, BOW, onset of labor. 4 2. Check vital signs. 1 3. Conduct physical examination. 2 4. Perform Leopolds maneuver. 2 5. Check Fetal Heart Rate and Fundic Height. 2 6. Monitor progress of labor/uterine contractions as to 1 Frequency 1 Duration 1 Intensity 1 Interval 7. Observes for the timely rupture of membrane. 1 8. Coaches mother on process of labor. 2 PERFORM FUNCTION DURING ACTUAL LABOR 1. Transport client safely while providing privacy. 1 2. Places mother in lithotomy position. 1 3. Perform perineal care using sterile technique correctly. 1 4. Perform proper hand scrub. 1 5. Wear gown and gloves according to hospital policy. 1 6. Perform Ritgens maneuver safely. 2 7. Coaches mother on breathing and pushing techniques. 1 8. Delivers baby and placenta carefully. 1 Checks and manages cord recoil correctly. 1 Clamps and cuts the cord correctly. 1 Identify signs of placental separation. 1 Check the characteristics/completeness of the placenta. 9. Assesses amount of blood loss (Normal: <500cc) 2 10. Employ interventions to achieve and maintain a well contracted uterus to Prevent/ control hemorrhage. 1 Uterine massage 1 Correct administration of oxytocin. 1 Cold compress. 11. Assesses presence and degree of laceration. 1 12 Assist in episiorrhahy. 1 13. Check size, consistency and location of uterus. 1 14. Perform Perineal care and applies pad correctly. 1 15. Provide emotional support to the mother throughout labor and delivery. 1 16. Evaluate patients for transfer to recovery room/ward. 2 17. Prepare patient for transfer to recovery room/ward. 1 II. MANAGEMENT OF RESOURCES, ENVIROMENT AND EQUIPMENT (MRE) 1. Prepare room, instruments and equipment needed. 1 Sterile drape. 1 Sterile instruments and equipment . 1 Kelly pad. 1

Disinfectant. 2. Perform sterilization procedure. 3. Maintain adequacy of supplies as the delivery progresses. 4. Maintain orderliness of the sterile table 5. Observes precautionary measures related to use of electrical equipment. 6. Ensures a quiet environment. 8. Ensure proper disposal of hospital waste including blood and other fluids. III. HEALTH EDUCATION (HE) 1. Teaches client on basic preparation during labor and deliver (can be done in the labor room) 2. Coaches client on breathing/bearing down technique. 3. Demonstrate proper latch-on breast feeding technique (done post-partum period) 4. Gives instructions to parents regarding infant care before discharge (done post-partum period) 5. Provide discharge instructions as to feeding, bathing, administration of Ordered medicines, appointment dates for post natal and well baby Check-up(done post-partnum period) 6. Respond to questions of clients and relatives regarding expectations. IV. LEGAL RESPONSIBILITIES (LR) 1. Secure informed consent in all procedures related to labor and delivery. 2. Report accurately and honestly the gender, time of delivery 3. Ensure proper identification of the mother and newborn. 4. Document all pertinent data correctly and completely. V. ETHICO-MORAL RESPONSIBLITIES (EMR) 1. Respect the religious, cultural and ethnic practices of the family of the Woman in labor and delivery. 2. Promote emotional security by supporting needs. 3. Accepts criticism and recommendations. 4. Perform functions according to standards. VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Update oneself with the latest trends and development in labor and Delivery. 2. Project a professional image of a delivery room nurse. 3. Accepts criticisms and recommendations. 4. Perform functions according to standards. VII. QUALITY IMPROVEMENT (QI) (PREFERABLY DONE DURING POST CONFERENCE) 1. Identifies deviation of practice from the standards. 2. Participate in audit practices in the delivery room/lying in. 3. Recommend corrective and preventive measures for the identified Deviations. VIII. RESEARCH ( R ) ( PREFERABLY DONE DURING POST CONFERENCE) 1. Identifies researchable problems related to labor and delivery. 2. Utilize findings of research studies in intra-partal care. IX. RECORDS MANAGEMENT ( R ) 1. Documents accurately relevant data about client.

1 1 1 1 1 1

1 2 1 1 1 1 1 2 2 1

1 1 1 1

1 1 1 1

1 1 1 2 2 1

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. Inform clients significant others of the progress of labor and delivery. 3. Listens attentively to clients and families queries and request.

1 1 1

XI. COLLABORATION AND TEAM WORK (CTW) 1. Functions effectively as 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 SCORE 1 1 1 90

* CERTIFIED TRUE AND CORRECT (Signature over Printed Name)

Mylene R. Pulutan, RN, MAN Clinical Instructor License Number: 0189573 PRC Card Validity Date: 09-18-14

Yvette V. Agarao, RN, MAN Clinical Coordinator License Number: 0358494 PRC Card Validity Date: 08-20-13

Herman F. Zoleta, RN, MAN College Dean License Number: 0244486 PRC Card Validity Date: 11-11-12

2011-2012 Academic Year Graduated