COLLEGE OF NURSING

EVALUATION TOOL
INTRA OPERATIVE CARE COMPETENCY

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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 the Student: ______________________________________

DESIRE 1st 2nd 3rd Average

NEWBORN COMPETENCIES D RLE RLE RLE Rating
RATING
I.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 warmly. 1
 Places under droplight as needed
5. Performs and interprets APGAR scoring correctly.
 Immediately after delivery 2
 After 5 minutes 2
6. Ensures proper identification of newborn (name tag: name of 2
mother, date and time of delivery, gender and name of
attending physician).
5.
7. Observes precautionary
Performs physician measures related to use of
assessment. 12
electrical equipment.
8. Takes anthropometric measurements including weight, 2
6. Ensures a warm
height, head, and abdominal
chest, quiet environment
circumference. 1
7.
9. Uses
Takessupplies
vital signsdiligently.
(temperature per rectum to check patency) 11
8. Ensures proper disposal of hospital waste.
10. Gives oil/ water and soap bath according to institutional 11
III. HEALTH
policy. EDUCATION (HE)
1.
11.Provides
Latches instructions
newborn to the to the motherbreast
mother’s on daily cord care and
immediately after 21
prevention
birth. of cord infections
2.
12.Provides
Applies discharge
CREDE’sinstructions
prophylaxistoonthe themother
eyes. on when to 11
expect cord to fall off or to
13. Performs cord dressing aseptically. report signs of cord infections.
3. Provides
 information
Disinfects area regarding
properlynewborn
accordingscreening,
to hospital policy 21
immunization,
 feeding, etc.
Clamps and cuts cord 1 inch from the abdomen 1
4. Responds
 to questions of mother and relatives
Checks for the presence of 2 arteries and 1 veinregarding 11
expectations.
 Dresses cord aseptically according hospital policy 1
IV. LEGAL RESPONSIBILITIES (LR)
14. Administers
1. Identifies Vitamin
newborn K (1 mg/M)IDinto
by comparing bandthewith
lateral
dataanterior
in the 21
thigh
chart. or vastus lateralis.
15. Keeps babyallwrapped
2. Documents pertinentwarmly under floor
data correctly and lamp or beside
completely. 11
mother according to institutional policy
3. Reports accurately any deviations/ abnormal findings and until discharge. 1
16.nursing
Records pertinent observations
interventions rendered. and nursing care done. 1
17. Reports any signs of deviation/ abnormality to
4. Ensures that birth certificate and other civil registration forms the 21
pediatrician.
are accomplished/ filled out according to institutional policy.
II. MANAGEMENT
5. Performs foot printing OFaccording
RESOURCES, EVIRONMENT
to hospital policy. AND EQUIPMENT (MRE)
1
1. Prepares instrument and
V. ETHICO – MORAL RESPONSIBILITIES (EMR)equipment needed
 Suctions
1. Respects the bulb, cord cultural
religious, clamp, gauze, cotton
and ethnic balls, disinfectant,
practices of the blanket, 14
droplight, Vitamin
family of the newborn. K, antimicrobial ophthalmic ointment.
2.
2. Ensures
Maintains use of sterile
privacy andequipment during
confidentiality ofimmediate
findings ofcare of 11
the newborn.
assessments.
3.
VI.Maintain
PERSONAL adequacy AND ofPROFESSIONAL
supplies as newbornDEVELOPMENT
care is rendered (PPD) 1
4. Maintains orderliness of the working area.
1. Updates oneself with the latest trends and developments in 11
newborn care.
2. Projects a professional image of the pediatric nurse. 1
3. Accepts criticisms and recommendations. 1
4. Performs functions according to standards. 1
VII. QUALITY IMPROVEMENT (QI)
1. Identifies deviation of practice from the standards. 1
2. Participates in audit practices in the nursery. 1
3. Recommends corrective and preventive measures for the 1
identified deviations.
VIII. RESEARCH (R)
1. Identifies researchable problems related to immediate care of 1
newborn.
2. Initiates a research study on an identified researchable 1
problem.
3. Participates as a member of a research team in the 1
conduction of a research study.
4. Utilizes findings of research studies in the immediate care of 1
the newborn.
 IX. RECORDS MANAGEMENT (RM)
1. Documents accurately relevant data about the newborn. 1
2. Maintains an organized system of filing and record keeping. 1
X. COMMUNIATION (Comm)
1. Utilizes appropriately all forms of communication; verbal, non- 1
verbal, electronic.
2. Maintains an open line of communication with the mother and 1
other family members.
3. Informs mother of relevant information about the newborn. 1
4. Listens attentively to queries and requests of mothers and 1
family members.
XI. COLLOBORATION AND TEAMWORK (CTM)
1. Functions effectively as a team player in the nursery. 1
2. Communicates findings of assessment to all concerned. 1
3. Establishes a collaborative relationship with members of the 1
health team and family of the newborn.
TOTAL SCORE 75

When Graded RLE’s were performed (Specify Academic Year and Semester):

First Graded RLE : Academic Year __________________ 1ST Sem_ 2nd Sem. __ Summer____
Clinical Instructor : Name_________________________ Signature_____________________
: License Number________________ Validity ______________________

Second Graded RLE : Academic Year __________________ 1ST Sem_ 2nd Sem. __ Summer____
Clinical Instructor : Name_________________________ Signature_____________________
: License Number________________ Validity ______________________

Third Graded RLE : Academic Year __________________ 1ST Sem_ 2nd Sem. __ Summer____
Clinical Instructor : Name_________________________ Signature_____________________
: License Number________________ Validity ______________________

Verified True and Correct: _____________________________ License Number_____________

(Signature over Printed Name) Clinical Coordinator Validity______________________

Academic Year Graduated: ___________________

___________________________ License Number: _______________

DEAN Validity Date ________________
Signature over Printed Name
UC-VPAA-CON-FORM-14 Page 1of 5
JUNE 2012 REV 00