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PERFORMANCE EVALUATION CHECKLIST INTRA-PARTAL COMPETENCY

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					                              PERFORMANCE EVALUATION CHECKLIST
                                      INTRA-PARTAL COMPETENCY


Name of Student: ____________________________________________________________
Year/Clinical Group: _____________________School Year: __________________________
Semester/Term: ________ First Semester _________ Second Semester _________Summer
Inclusive Dates of Clinical Rotation: ______________________________________________

        INTRAPARTAL COMPETENCIES                      WEIGHT   SCORE         REMARKS
 I.        SAFE AND QUALITY NURSING CARE
 1. Obtains obstetrical history including parity,       4
    gravid score, LMP, EDC, 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
    as to:
                                                        1
 - Frequency
 - Duration                                             1
 -     Intensity                                        1
 -     Interval                                         1
 7. Observes for timely rupture of membrane             1
 8. Coaches mother on process of labor                  2
 II.    PERFORMS FUNCTIONS DURING
        ACTUAL LABOR
 1. Transports clients safely while providing           1
    privacy
 2. Places mother in lithotomy position                 1
 3. Performs perineal care using sterile technique      1
    correctly
 4. Performs proper hand scrub                          1
 5. Wears gown and gloves according to hospital         1
    policy
 6. Performs Ritgen’s maneuver safely                   2
 7. Coaches mother on breathing and pushing             1
    techniques
 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 characteristics/ completeness of        1
     the placenta
 9. Assesses amount of blood loss                       2
     (Normal: <500cc)
 10. Employs interventions to achieve and
     maintain a well contracted uterus to prevent/
     control hemorrhage
 - Uterine massage                                      1
 -     Correct administration of oxytocin               1
 -     Cold compress                                    1
     INTRAPARTAL COMPETENCIES                       WEIGHT   SCORE   REMARKS
11. Assesses the presence and degree of               1
    laceration
12. Assists in epissioraphy                           1
13. Checks size, consistency, and location of         1
     uterus
14. Performs perineal care and applies pad            1
     correctly
15. Provides emotional support to the mother          1
     throughout labor and delivery
16. Evaluates patient’s condition and records         2
     pertinent data accordingly
17. Prepares patient transfer to recovery room/       1
     ward
III.     MANAGEMENT OF RECOURCES,
         ENVIRONMENT, AND EQUIPMENT
1. Prepares room, instruments, and equipments
     needed.
                                                      1
- Sterile drape
-   Sterile instruments and equipments [forceps,
    scissors, bulb syringe, gauze, suture, needle
                                                      1
    holder, catheter (optional)]
-   Kelly pad                                         1
-   Disinfectant                                      1
2. Performs sterilization procedure                   1
3. Maintains adequacy of supplies as the              1
   delivery progresses
4. Maintains orderliness of the sterile table         1
5. Observes precautionary measures related to         1
   the use of electrical equipment
6. Ensure a quiet environment                         1
7. Uses supplies diligently                           1
8. Performs after care of the materials and           1
    equipments used
9. Ensure proper disposal of hospital waste           1
    including blood and other fluids
IV.     HEALTH EDUCATION
1. Teaches client on basic preparation during         1
   labor and delivery
2. Coaches client on breathing/ bearing down          2
   technique
3. Demonstrates proper “latch-on” breastfeeding       1
   technique
4. Gives instructions to parents regarding infant     1
   care before discharge
5. Provides discharge instructions as to feeding,
   bathing, administration of ordered
                                                      1
   medications, appointment dates for post natal
   and well baby check up
6. Responds to questions of clients and relatives     1
   regarding expectation
V.     LEGAL RESPONSIBILITY
1. Secures informed consent in all procedures         1
   related to labor and delivery
2. Reports accurately and honestly the gender,        2
   time of delivery of the baby and placenta
3. Ensures proper identification of the mother        2
   and newborn
4. Documents all pertinent data correctly and         1
   completely
         INTRAPARTAL COMPETENCIES                     WEIGHT     SCORE                 REMARKS
 VI.      ETHICO-MORAL RESPONSIBILITY
 1. Respects the religious, cultural, and ethnic
    practices of the family of the woman in labor
                                                        1
    and delivery
 2. Promotes emotional security by supporting           1
    needs
 3. Ensures privacy and confidentiality                 1
 VII.   PERSONAL AND PROFESSIONAL
        DEVELOPMENT
 1. Updates oneself with the latest trends and          1
    developments in labor and delivery
 2. Projects a professional image of a delivery         1
    room nurse
 3. Accepts criticisms and recommendations              1
 4. Performs functions according to standards           1
 VIII.    QUALITY IMPROVEMENT
 1. Identifies deviation of practice from the           1
     standards
 2. Participates in audit practices in the delivery     1
     room/ lying in
 3. Recommends corrective and preventive                1
     measures for the identified deviations
 IX.     RESEARCH
 1. Identifies researchable problems related to         1
    labor and delivery
 2. Initiates a research study on an identified         1
    researchable problem
 3. Participates as a member of a research team         1
    in the conduction of a research study
 4. Utilizes findings of research studies in intra-     1
    partal care
 X.      RECORDS MANAGEMENT
 1. Documents accurately relevant data about            1
     the client
 2. Maintains an organized system of filing and         1
     keeping records of the client
 XI.     COMMUNICATION
 1. Utilizes appropriately all forms of                 1
      communication: verbal, non-verbal, electronic
 2. Informs client’s significant others of the          1
      progress of labor and delivery
 3. Listens attentively to clients and families         1
      queries and requests
 XII.    COLLABORATION AND TEAMWORK
 1. Function effectively as a team player in the        1
    delivery room/ lying-in
 2. Communicates the progress of labor/ delivery        1
    to significant others
 3. Establishes a collaborative relationship with
    members of the health team and family
                                                        1
    members
                TOTAL SCORE                             90


EVALUATED BY:


         _______________________________                     ________________________________
            Signature over Printed Name                           Signature over Printed Name
                 Clinical Instructor                                         Student

				
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