PERFORMANCE EVALUATION TOOL

NCM 107- Care of the Mother , Child and Family

Care of Mother during Postpartum

Name: _________________________ Year & Section: ______ Date: ________ Grade: _______

Direction: Rate the student in terms of the skills/competencies listed below by putting a check mark
(/) in the appropriate column. Sum up the scores for each item to get the total score.

Legend: DR –Desired Rating

D - Done
ND -Not Done

PERFORMANCE INDICATORS D N Score REMARKS

DR D
1. APPLY BASIC KNOWLEDGE IN THE
PRACTICE OF NURSING
1. Integrate relevant principles of social, physical, 2
natural and health sciences and humanities in a
given health and nursing situation.
2. Apply appropriate nursing concepts and actions 2
holistically and comprehensively.
2. EFFECTIVE COMMUNICATION AND
CULTURALLY SENSITIVE INTERACTION
1. Establishes rapport with the client 2
2. Utilizes therapeutic communication to facilitate the 2
intervention.
3. Responds to the needs of the client and health care 2
team.
4. Spends time with the client to encourage 2
verbalization and expression of concerns.
5. Work with the client, support group and team based 2
on trust, respect and shared relevant information
regarding patient’s condition and decision making
using appropriate communication techniques.
3. PRACTICE BEGINNING MANAGEMENT AND
LEADERSHIP SKILLS.
1. Manage resources efficiently and effectively
a) Provide a private, caring and quiet environment at 1
all times
b) Prepares room and manages materials/equipment. 1
c) Uses supply diligently 1
d) Performs after care of the materials and equipment 1
used.
e) Ensures proper disposal of hospital waste. 1
4. SAFE APPROPRIATE AND HOLISTIC CARE
A. ASSESSMENT
1. Determine significant health history
a) Pregnancy History (Gravida and Para status, 2
expected date of birth, whether pregnancy was
planned, any problems or complications occurred) 2
b) Labor and Birth History (length of labor, position
of fetus, type of birth, analgesia or anesthesia used,
problems during labor, presence of perineal
sutures)
c) Infant Data (sex, weight of the infant, any difficulty 2
at birth, any congenital anomalies present)
2. Checks vital signs 2
(Temperature, Pulse, Respirations, Blood Pressure and
Pain)
3. Monitors emotional status 2
(Interaction with family, Level of Independence,
Energy levels, Eye contact with infant, posture and
comfort level while holding the infant, sleep and rest
patterns, mood swings, irritability, crying episodes)
4. Assess patient’s Breast
a) Inspect for breast size, contour, asymmetry, 2
engorgement, erythema)
b) Inspect nipples if flat, erect or everted. 2
c) Check nipples for cracks, redness, fissures and 2
bleeding
d) Palpate breasts lightly to ascertain if its soft, filling 2
or engorged
e) Palpate breast tissue for any nodules, masses or 2
areas of warmth (plugged ducts, mastitis)
f) Observe for colostrum (creamy white), foremilk 2
(bluish white) or hind milk
5. Auscultate bowel sounds in all four quadrants 2
6. Palpate abdomen for presence of tenderness. 2
7. Assess the fundus (top portion) of uterus and determine
the degree of involution.
a) Position patient in woman supine with knees 2
slightly flexed.
b) Observe abdomen for contour, appearance of striae 2
or diastasis and detect distention.
c) Palpate the position, location and height of the 2
funds using a two-hand approach (one hand on the
fundus, and the other hand on the lower segment).
d) Place index finger on the fundus and count the number of 2
fingerbreadths between the fundus and the umbilicus
e) Palpate and check the consistency of uterus (firm, 2
soft or boggy)
8. Check perineal pad and evaluate character of lochia 2
(amount color, odor, presence of blood clots).
9. Assess the bladder for distention and adequate
emptying after efforts to void. 2
a) Palpate the are over symphysis pubis for over
distention 2
b) Percuss the area over symphysis pubis for dullness.
10. Check perineum for presence of pooling of lochia
and episiotomy. 2
a) Position in side-lying position with top leg flexed
upward at the knee and drawn up toward her waist. 2
b) Gently lift upper buttocks to expose the perineum
and anus. 2
c) Inspect perineum for presence of bleeding, redness,
irritation, ecchymosis, tenderness or hematomas,
inflammation and intactness. 2
d) Assess rectal area for presence of hemorrhoids.

B. DIAGNOSIS
1. State priority problem/ nursing diagnosis 2
C. PLANNING
1. Formulate with the client a plan of care to address the 2
conditions, needs, problems, and issues based on
priorities.
D. IMPLEMENTATION
1. Implement safe and quality interventions with the client
to address the health needs, problems and issues.
a) Explain procedures to the client 2
b) Provides safe and comfort measures 2
c) Ensures/ maintains well contracted uterus to prevent 2
hemorrhage.
- Uterine massage
- Application of cold compress
- Checks prescribed rate of IV flow
- Ensures adequate hydration
- Monitors intake of oral fluids.
- Provides perineal care and applies pad
correctly. 2
d) Reestablishes bladder function.
- Offering bedpan
- Encourage early ambulation 2
e) Prevents postpartum complications
- Promotes early ambulation, exercise and
perineal self-care 2
2. Administers prescribed pharmacological therapy 2
3. Provide health education using selected planning
 models to targeted clientele
a) Emphasizes the importance of:
- Breastfeeding, proper suckling technique, 2
burping
- Diet/ Nutrition
- Activity/Exercise
- Newborn Screening
- Well baby check-up and Immunization
- Follow up/ postnatal visits
b) Provides teachings in alleviating discomforts during
postpartum period (afterpains, pain, constipation, 2
breast engorgement, feelings of emotional lability,
etc.)
c) Informs the client on managing the different danger
signs of during postpartum period (soft and non- 2
contracting uterus, fever and chills, increased blood
pressure, etc)
E. EVALUATION
1. Check patient’s response throughout the interaction 2
2. Evaluate with the client the health status/competence/ 2
and/or process/expected outcomes of nurse-client
working relationship.
5. APPLY GUIDELINES AND PRINCIPLES OF EBP
1. Provide appropriate evidence-based nursing care using
a participatory approach based on
a) Variety of theories and standards relevant to health 2
and healing
b) Client preferences 2
c) Client and staff safety 2
d) Customer care standards. 2
6. COLLABORATE EFFECTIVELY WITH INTER-,
INTRA-, AND MULTI-DISCIPLINARY AND MULTI-
CULTURAL TEAMS.
1. Maintain a harmonious and collegial relationship 2
among members of the health team for effective,
efficient and safe client care
7. PRACTICE NURSING IN ACCORDANCE WITH
EXISTING LAWS, LEGAL, ETHICAL AND MORAL
PRINCIPLES.
1. Adhere to ethico-legal considerations when providing 2
safe, quality and professional antenatal care.
2. Apply ethical reasoning and decision-making process 2
to address situations of ethical distress and moral
dilemma.
3. Adhere to established norms of conduct based on the 2
Philippine Nursing Law and other legal, regulatory
 and institutional requirements relevant to safe nursing
practice.
4. Protect client’s rights based on “Patient’s Bill of
Rights and Obligations.” 2
5. Implement strategies/policies related to informed
consent as it applies to antenatal care. 2
8. ENGAGE IN LIFELONG LEARNING/ RESEARCH
1. Assume responsibility for lifelong learning, own
personal development and maintenance of
competence.
a) Cites and updates oneself with the latest trends and 1
development in the care of a postpartum mother.
9. ADOPT RESPONSIBLE CITIZENSHIP AND UPHOLD
THE NURSING CORE VALUES IN THE PRACTICE
OF THE PROFESSION.
1. Customize nursing interventions based on Philippine
culture and values.
a) Respects cultural and ethnic practices. 3
2. Manifest professionalism, integrity, excellence.
a) Attendance 3
b) Complete Uniform 3
c) Respect and proper decorum 3
3. Project the positive professional image of the 3
Filipino Nurse
10. DOCUMENTATION AND REPORTING
1. Document client’s responses/nursing care services 2
rendered and processes/outcomes of the client
working relationship.
2. Ensure completeness, integrity, safety, accessibility 2
and security of information.
3. Adhere to protocol and principles of confidentiality 2
in safekeeping and releasing of records and other
information.
SCORE 139

TOTAL GRADE: ________________________________

Points Grade
139 100
138 99
137 98
136 97
135 96
134 95
133 94
 132 93
131 92
130 91
129 90
128 89
127 88
126 87
125 86
124 85
122 – 123 84
120 - 121 83
118 – 119 82
116 – 117 81
114 – 115 80
112 – 113 79
110 – 111 78
108 – 109 77
106 – 107 76
104 – 105 75
103 FAILED

Rating:
_________________________________ _____________________________
Signature over printed name of student Signature over printed name of C.I.