Hilltop Campus, Batangas City

Tel. # 723-1446 Loc. 603/ FAX # (043) 723 -4183/ www.ub.edu.ph

SUMMARY PERFORMANCE EVALUATION

ACHIEVING IMMEDIATE CARE OF THE NEWBORN COMPETENCY
In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Signature over Printed Name of Student: __________________________________________ _

Instruction: Give the appropriate rating for each item based on the given numerical rating.

Numerical Rating: Quantitative Description

4 3 2 1 Outstanding Consistently exceeds expectations.
3 2.25 1.25 .5 Competent Conforms to standards and frequently meets expectations
Carries out expected behavior with close guidance and
2 1.5 1 .5 Needs Improvement
supervision. Does not consistently meet expectations
Progress Does not carry out expected behavior even under close
1 .75 .5 .25
unacceptable guidance and supervision

DESIRED ACTUAL
NEWBORN COMPETENCIES
RATING RATING REMARKS
A. SAFE AND QUALITY NURSING CARE (SQC)
1. Establishes and maintains patent airway. 3
2. Puts the newborn in Trendelenburg position 1
3. Suctions mouth and nose of the newborn gently. 2
4. Dries newborn and wraps the newborn 1
• Places under droplight as needed
5. Performs and interprets APGAR SCORING
correctly
a. Immediately after delivery 2
b. After 5 minutes 2
6. Ensures proper identification of newborn (name 2
tag: name of mother, date and time of delivery,
gender and name of attending physician).
7. Performs physical assessment 2
8. Takes anthropometric measurements: head, 2
chest and abdominal circumference; weight,
height.
9. Takes vital signs (temperature per rectum to 1
check patency)
10. Gives oil/water and soap bath according to 1
institutional policy.
11. Latches newborn to the mother’s breast 1
immediately after birth.
12. Applies Crede’s prophylaxis on both eyes 1
13. Performs cord dressing aseptically
a. Disinfects area properly according to hospital 1
policy
b. Clamps and cuts cord at 1 inch from the 1
abdomen.
c. Checks for the presence of 2 arteries and 1 1
vein
d. Dresses cord aseptically according hospital 1
policy
14. Administers Vitamin K (1mg/m), Hepa B and 1
 BCG vaccines
15. Keeps baby wrapped warmly under floor lamp or 1
beside mother according to institutional policy
until discharge.
16. Records pertinent observations and nursing care 1
done.
17. Reports/refers any untoward manifestations to 1
the pediatrician
B. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT
(MRE)
1. Prepares instrument and equipment needed 4
• Suction bulb, cord clamp, gauze, cotton balls,
disinfectant, blanket, droplight, Vitamin K,
antimicrobial ophthalmic ointment
2. Ensures use of sterile equipment during 1
immediate care of the newborn
3. Maintain adequacy of supplies as newborn care 1
is rendered
4. Maintains orderliness of the working area 1
5. Observes precautionary measures related to the 1
use of electrical equipment
6. Ensures a warm and quiet environment 1
7. Uses supplies diligently 1
8. Ensures proper disposal of hospital waste. 1
C. HEALTH EDUCATION (HE)
1. Provides instruction to the mother on daily cord 2
care and prevention of cord infection
2. Provides discharge instructions to the mother on 1
when to expect cord to fall off or to report signs of
cord infection.
3. Provides information regarding the importance of 2
newborn screening, immunization, feeding, etc.
4. Responds to questions of mother and relatives 1
regarding expectations.
D. LEGAL RESPONSIBILITY
1. Identifies newborn by comparing ID band with 2
data in the chart.
2. Documents all pertinent data correctly and 1
completely.
3. Reports accurately any deviations/abnormal 1
findings and nursing interventions rendered.
4. Ensures that birth certificate and other civil 2
registration forms are accomplished/filled out
accordingly to institutional policy.
5. Performs foot printing according to hospital 1
policy.
E. ETHICO-MORAL RESPONSIBILITIES (EMR)
1. Respects the religious, cultural and ethnic 1
practices of the family of the newborn
2. Maintains privacy and confidentiality of findings of 1
assessments.
F. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)
1. Updates oneself with the latest trends and 1
developments in newborn care.
2. Projects a professional image of the pediatric 1
nurse.
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards 1
G. QUALITY EMPROVEMENT (QM)
1. Identifies deviation of practice from standards 1
2. Participates in audit practices in the nursery. 1
3. Recommends corrective and preventive 1
measures for the identified deviations
H. RESEARCH (R)
1. Identifies researchable problems related to 1
immediate care of newborn
2. Initiates a research study on an identified 1
researchable problem
3. Participates as a member of a research team in 1
the conduction of a research study.
4. Utilizes findings of research studies in the 1
immediate care of the newborn
I. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about the 1
newborn.
2. Maintains an organized system of filing and 1
record keeping.
J. Communication
1. Utilizes appropriately all forms of communication; 1
verbal, non-verbal and electronic.
2. Maintains an open line of communication with the 1
mother and other family members.
3. Informs mother of relevant information about the 1
newborn.
4. Listens attentively to queries and requests of 1
mothers and family members.
K. COLLABORATION AND TEAMWORK (CTM)
1. Functions effectively as a team player in the 1
nursery
2. Communicates findings of assessment to all 1
concerned
3. Establishes a collaborative relationship with 1
members of the health and family of the newborn.

TOTAL SCORE 75

Certified True and Correct:

(Signature over Printed Names)

________________________________________ ______________________________________
Clinical Instructor Clinical Coordinator
License Number: _________________________ License Number: _______________________
PRC Card - Validity Date: __________________ PRC Card – Validity Date: ________________

________________________________________
DEAN ______________________________________
License Number: _________________________ Academic Year Graduated
PRC Card - Validity Date: __________________