UNIVERSITY OF EASTERN PHILIPPINES University Town, Northern Samar COLLEGE OF NURSING (055)251-8360 SUMMARY PERFORMANCE EVALUATION ACHIEVING

INTRA-OPERATIVE CARE COMPETENCY

In Accordance with PRC, Board of Nursing Memorandum No. 01 Series 2009 Signature over Printed Name of Student: BLESSY L. MOSCARE

INTRAPARTAL COMPETENCIES

DESIRED RATING

ACTUAL RATING

I. SAFE AND QUALITY NURSING CARE (SQC) 1. Obtains obstetrical history including parity, gravid score, LMP, EDC, AOG,BOW onset of true labor. 2. Checks vital signs. 3. Conducts physical assessment. 4. Performs Leopolds maneuver. 5. Checks Fetal Heart Rate and Fundic height. 6. Monitor progress of labor/uterine contractions as to: Frequency Duration Intensity Interval 7. Observes for the timely rupture membrane. . Coaches mother on process of labor. PERFORMS FUNCTIONS DURING ACTUAL LABOR 1. Transports clients safely while providing privacy. 2. Places mother in lithotomy position. 3. Performs Perineal care using sterile technique correctly. 4. Performs proper hand scrub. 5. Wears gown and gloves according to hospital policy. 6. Perform Ritgensmaneuver safely. 7. Coaches mother on breathing and pushing techniques. 8. Delivers baby and placenta carefully. Checks and manages cord recoil correctly. Clamps and cuts the cord correctly. Identify signs of placental separation. Checks the characteristics/completeness of the placenta. 9. Assesses amount of blood loss (Normal: <500cc) 10. Employs interventions to achieve and maintain a well contracted uterus to prevent/control hemorrhage. Uterine massage Correct administration of oxytocin Cold compress 11. Assesses presence and degree of laceration. 12. Assists in episiorrhaphy. 13. Checks size, consistency and location of uterus. 14. Performs perineal care and applies pad correctly. 15. Provides emotional support to the mother throughout labor and delivery. 16. Evaluates patients condition and records pertinent data accordingly. 17. Prepares patient for transfer to recovery room/ward. II. MANAGEMENT OF RESOURCES, ENVIRONMENT AND EQUIPMENT (MRE) 1. Prepares room, instruments and equipment needed.
Sterile drape Sterile instruments and equipment [Forceps, scissors, bulb syringe, gauze, suture, needle holder, catheter (optional)]

4 1 2 2 2 1 1 1 1 1 2 1 1 1 1 1 2 1 1 1 1 1 2

4 1 2 2 2 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1

1 1 1 1 1 1 1 1 2 1 1

1 1 1 1 1 1 1 1 1 1 1

Kelly pad Disinfectant 1 1 1 1 1 1

2. Performs sterilization procedure. 3. Maintains adequacy of supplies as the delivery progresses. 4. Maintains orderliness of the sterile table.

5. Observes precautionary measures related to use of electrical equipment. 6. Ensures a quiet environment. 7. Uses supplies diligently. 8. Performs after care of the materials and equipment used. 9. Ensures proper disposal of hospital waste including blood and other fluids. III. HEALTH EDUCATION (HE) 1. Teaches client on basic preparation during labor and deliver (can be done in the labor room) 2. Coaches client on breathing down technique. 3. Demonstrate proper latch-on breast feeding technique (Done postpartum period). 4. Gives instructions to parents regarding infant care before Discharge (done post-partum period). 5. Provides discharge instructions as feeding, bathing, administration of ordered medications, appointment dates for post natal and well-baby check-up (done post-partum period). 6. Responds to questions of clients and relatives regarding expectations. IV. LEGAL RESPONSIBILITIES (LR) 1. Secures informed consent in all procedures related to labor and delivery. 2. Reports accurately and honestly the gender, time of delivery of the baby and placenta. 3. Ensures proper identification of the mother and newborn. 4. Documents all pertinent data correctly and completely. V. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. Respects the religious, cultural and ethnic practices of the family of the woman in labor and delivery. 2. Promotes emotional security by supporting needs. 3. Ensures privacy and confidentiality. VI. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD) 1. Updates oneself with the latest trends and development in labor and delivery. 2. Projects a professional image of a delivery room nurse. 3. Accepts criticism and recommendations. 4. Performs functions according to standards. VII. QUALITY IMPROVEMENT (QI) (preferably done during post conferences) 1. Identifies deviation of practice from the standards. 2. Participates in audit practices in the delivery room/lying in. 3. Recommends corrective and preventive measures for the identified deviations. VIII. RESEARCH (R)(preferably done during post conferences) 1. Documents accurately relevant data about client. 2. Utilize findings of research studies in intra-partal care. IX. RECORD MANAGEMENT (RM) 1. Documents accurately relevant data about client. 2. Maintains an organized system of filing and keeping records of the client X. COMMUNICATION (Comm) 1. Utilizes appropriately all forms of communication; verbal, non-verbal, electronic. 2. Inform clients significant others of the progress of labor and delivery. 3. Listens attentively to clients and families queries and requests. XI. COLLABORATION AND TEAMWORK (CTW) 1. Functions effectively as a team player in the delivery room/lying in. 2. Communicates the progress of labor/delivery to significant others. 3. Establishes collaborative relationship with members of the health team and family members. TOTAL GRADE

1 1 1 1 1

1 1 1 1 1

1 2 1 1 1

.5 .5 1 1 1

1 2 2 1 1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 1 1

1 1 1 .5

1 1 1 1 1 1 90 2.00

.5 1 1 1 1 1 79

Certified True and Correct:

MARYFLOR L. CAGRO, RN, MAN Clinical Instructor License Number: 0191585 PRC Card-Validity Date: March 16, 2014

RONA L. ALCERA, RN, MAN Coordinator License Number: 0178033 PRC Card-Validity Date: May 11, 2015

MARY DAY E. FLORANO RN, MAN Clinical Instructor License Number: 0312835 PRC Card-Validity Date: September 1, 2013

MARIA LINDA S. AGUS, RN, MAN DEAN License Number: 0178033 PRC Card-Validity Date: March 8, 2014

School Year 2012-2013 Academic Year Graduated

UNIVERSITY OF EASTERN PHILIPPINES University Town, Northern Samar COLLEGE OF NURSING (055)251-8360

SUMMARY PERFORMANCE EVALUATION ACHIEVING INTRA-PARTAL CARE COMPETENCY In Accordance with PRC Board of Nursing Memorandum No. 01 Series 2009

Signature over Printed Name of Student: BLESSY L. MOSCARE INTRA-OPERATIVE CARE COMPETENCIES I. SAFE AND QUALITY NURSING CARE (SQC) 1. Utilizes the nursing process in the care of OR client. a. Obtains comprehensive clients information. b. Identifies priority needs of the client at the Operating Room c. Provides needed nursing interventions based on identified needs. d. Monitors clients responses to surgery. 2. Promotes safety and comfort of patients inside the OR. 3. Promotes the functions of the scrub nurse. a. Performs surgical scrub correctly. b. Wears sterile gowns and gloves aseptically. c. Prepares surgical instruments, sponges, sutures and othersupplies in functional arrangement. d. Hands instruments, sponges, sutures and other needed materials according to surgeons preference. e. Performs surgical count accurately. 4. Performs the functions of the circulating nurse. a. Anticipates the needs of the surgical team. b. Sets up the OR room and needed equipment. c. Receives client for surgery/endorses client postoperatively. d. Assists in skin preparation and draping of client. 5. Administers medications and other health therapeutics safely. II. MANAGEMENT OF RESOURCES AND ENVIRONMENT (MRE) 1. Organizes work load to facilitate timely patient care 2. Utilizes adequate and appropriate resources to support the OR team. 3. Ensures functionality of OR resources. 4. Maintains a safe environment at the OR by observing the principles of asepsis. III. HEALTH EDUCATION (HE) 1. Implements appropriate health education activities to client based on needs assessment.
IV. LEGAL RESPONSIBILITIES (LR) 1. Adheres to legal and institutional protocols regarding informed consent. V. ETHICO-MORAL RESPONSIBILITIES (EMR) 1. Respects the rights of the OR clients 2. Accepts responsibility and accountability for own decisions and actions as an OR nurse. VI. PERSONAL AND PROFESIONAL DEVELOPMENT (PPD) 1. Performs OR functions according to professional standards. 2. Possesses positive attitude towards learning surgical and ORrelated knowledge and skills. VII. QUALITY IMPROVEMENT 1. Participates in quality improvement activities related to infection control and successful OR operations. 2. Identifies and reports variances in sterility and other OR activities. VIII. RESEARCH 1. Disseminates results of OR-related research findings to clinical group and other members of the OR team as

DESIRED RATING 4 4 4 2 2 4 2 2 2 2 2 2 2 2 2

1 RLE 3 3 3 2 2 4 2 2 2 2 2 2 2 1 1

ST

2 RLE 3 3 3 2 2 3 2 2 2 1 2 2 2 2 2

ND

3 RLE 4 3 3 2 2 4 2 2 2 1 2 2 2 2 2

RD

AVERAGE RATING 3.33 3 3 2 2 4 2 2 2 1.33 2 2 2 1.66 1.66

4 2 2 2

3 2 2 2

3 1 2 1

4 2 2 2

3.33 1.66 2 1.66

1.66

1.66

2 2

1 1

1 2

2 2

1.33 1.66

4 2

4 2

3 2

4 2

3.66 2

2 2

2 1

2 2

2 2

2 1.66

1.66

appropriate. IX. RECORD MANAGEMENT 1. Maintain accurate and updated documentation of patient care. X. COMMUNICATION 1. Establishes rapport with patients, significant others and members of the health team. 2. Uses Appropriate information mechanism to facilitate communication inside the OR and with other departments in the hospital. XI. COLLABORATION AND TEAMWORK (CTM) 1. Collaborates plan of care with other members of the health team. TOTAL GRADE Certified True and Correct:

1.66

1 2

1 2

1 1

1 2

1 1.66

2 75

1 69

2 68 2.25

2 68

1.66 64.98

MARYFLOR L. CAGRO, RN, MAN

Clinical Instructor License Number: 0191585 PRC Card-Validity Date: March 16, 2014

RONA L. ALCERA, RN, MAN Clinical Coordinator License Number: 0178033 PRC Card-Validity Date: May 11, 2015

MARY DAY E. FLORANO RN, MAN Clinical Instructor License Number: 0312835 PRC Card-Validity Date: September 1, 2013

MARIA LINDA S. AGUS, RN, MAN DEAN License Number: 0147802 PRC Card-Validity Date: March 8, 2014

School Year 2012-2013 Academic Year Graduated

PRC APP FORM No. 005 (October 2003)

CERTIFICATION/TESTIMONIAL OF GOOD MORAL CHARACTER

TO WHOMSOEVER THESE PRESENTS MAY COME:

Upon my oath as a registered professional, I hereby CERTIFY that:

1. BLESSY L. MOSCARE an applicant for the NURSE licensure examination to be held on December 2013 is personally known to me to be a person of good moral character. 2. She has not been convicted of any act of omission punishable by law, rule or Regulation before a prosecutor, judge, public officer or administrative body, nor found culpable by any court or administrative body or any crime or offense involving moral turpitude; and 3. I am in a position to state the foregoing facts because I have known said applicant since 20092013 for a period of (4) years now.

WITNESS MY HAND this 3rd day of June 2013 at College of Nursing, University of Eastern Philippines, University Town, Northern Samar, Philippines.

MARIA LINDA S. AGUS, MAN Dean Profession: Registered Nurse License/ Cert. No. 0147802 Date of Registration: September 20, 1985 Validity no of PRC ID: March 8, 2014 Office/ Address: College of Nursing University Town, Northern Samar Residence: University of Eastern Philippines Catarman Northern Samar Tel No/ Cell Phone No.: 09999948067

Republic of the Philippines UNIVERSITY OF EASTERN PHILIPPINES University Town, Northern Samar COLLEGE OF NURSING

This is to certify that Ms. Asuncion Ibale Ponce, a BSN graduate of 2013 of University of Eastern Philippines College of Nursing;

1. has successfully completed all the competency requirements and number of cases as stipulated under the Philippine Nursing Curriculum, CMO no. 14, s. 2009; 2. that such record of competency requirements were submitted to the Commission On Higher Education (CHED), Copies of which are kept in the Office of the Registrar and the College of nursing, and 3. that under pain of legal sanction, we attest to the completion of such competency requirements.

Rogelio A. Banagbanag, DALL University Registrar Date Signed:__________

Maria Linda S. Agus, RN MAN College Dean Date Signed:__________

SUBSCRIBE AND SWORN TO BEFORE ME. THIS ___ DAY of __________, Affiant having exhibited to me his or her valid ID#________________

Doc. No. ______ Page No. ______ Book No. ______ Series of 20_____