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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 (Managed Case)


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)

Name of Patient (Initials only) / Clinical Instructor’s Signature:

Case No.1 ___________________________________

Case No.2 ___________________________________
Case No.3 ___________________________________
1st 2nd 3rd Average
Case Case Case Rating
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 Leopold’s 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 Ritgen’s Maneuver safely.

14. Coaches mother on proper breathing and pushing techniques.

1st 2nd 3rd Average

Case Case Case Rating
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 patient’s condition and records pertinent data.

24. Prepare patient for transfer to recovery room/ward.

II. Management Of Resources, Environment, And Equipment

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
III. Health Education

33. Demonstrate to client on breathing/bearing down technique.

34. Demonstrates proper “latch-on” breast feeding technique.

1st 2nd 3rd Average

Case Case Case Rating

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

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.

54. Utilizes proper channel of communication

XI. Collaboration And Teamwork

55. Functions effectively as a team member in the delivery room /lying-in


Certified True and Correct:

(Signature over Printed Name)


____________________________ _______________________________ ____________________________

Clinical Instructor Clinical Instructor Clinical Instructor

PRC License No. _____________ PRC License No. _____________ PRC License No. ______________
Valid until: __________________ Valid until: __________________ Valid until: ___________________

Noted By: ______________________________________

BS Nursing Level Coordinator

License No. _________________

Valid Until: _________________