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CU-QMS-NURSING-002

CAPITOL UNIVERSITY
COLLEGE OF NURSING
Cagayan de Oro City

EFFICIENCY RATING FOR DELIVERY ROOM EXPERIENCE

Name: ________________________________ Date of Experience:____________________


Class: ________________________________ Rating: ______________________________

I. KNOWLEDGE / COGNITIVE RATING

1. Identifies stages of labor basing on presenting sign and 4 3 2 1


symptoms.
2. Identifies signs and symptoms of any abnormalities or 4 3 2 1
complications in actual delivery
3. Anticipate problems with any abnormal responses/ reactions. 4 3 2 1
4. Identifies appropriate action/approach and correlate them to 4 3 2 1
what is being anticipated as needs
5. Identifies criteria in formulating objectives. 4 3 2 1
6. Discuses comprehensively what to expect during labor such as:
 signs and symptoms of different stages 4 3 2 1
 uterine contraction (duration, interval, intensity,
and frequency.) 4 3 2 1
 Bearing down sensation
 Procedure to be performed and importance
(internal examination, Cauterization, Episiotomy and
Episiorrhapy) 4 3 2 1
7. Interpret doctor’s orders correctly and correlate significant
laboratory result 4 3 2 1
8. Identifies and interprets legal implication of proper
documentation of nursing action given to the patients. 4 3 2 1
9. Anticipate discharge planning. 4 3 2 1
10. Monitors / evaluate laboring clients response to therapy and
nursing intervention. 4 3 2 1

II. SKILLS / PSYCHOMOTOR (40%)

1. Assess the laboring client’s status 4 3 2 1


2. Gather pertinent data through observations, interview
or other non-verbal documentation. 4 3 2 1
3. Formulate define and prioritize nursing problems
and identify appropriate nursing actions.
- Utilize appropriate plans and implements based on
identified physical and psychological needs. 4 3 2 1
4. Admission of mother to the labor room:
- Gather data completely
- Provision of psychological support/ building of rapport 4 3 2 1
5. Coaches mother to do specific breathing exercise during
specific stages of labor. 4 3 2 1
6. Labor watching
- Vital sign monitoring 4 3 2 1
- Leopold maneuver 4 3 2 1
- FHB monitoring and assessing of fetal condition 4 3 2 1
- Encourage mother to empty bladder regularly. 4 3 2 1
- Promotes rest by minimizing disturbance of mother
in between period of contraction 4 3 2 1
- Monitoring uterine contraction 4 3 2 1
- Assist in doing vaginal examination 4 3 2 1
7. Performs the following with due application of the nursing
principals involved. 4 3 2 1
- IVF infusion (assist during insertion and proper regulation 4 3 2 1
- Catheterization 4 3 2 1
- Skin testing 4 3 2 1
- Drug administration 4 3 2 1
8. Circulates during the actual delivery
- Anticipate the needs of delivery team 4 3 2 1
- Observe and assesses the reaction of patients 4 3 2 1
- Performs perineal care aseptically 4 3 2 1
- Prepares all the material needed for delivery, including
Some equipment, (crib, blanket, diaper, etc.) 4 3 2 1
- Performs after care of equipments in DR 4 3 2 1
- Promoting mother and child bonding through latching
On (Early breastfeeding) for 20-30 minutes 4 3 2 1

- Calling a ward man 4 3 2 1


- Perform environmental sanitation 4 3 2 1
9. Scrub during delivery
- Identifies function and responsibilities 4 3 2 1
- Observe correct gowning and gloving 4 3 2 1
- Proper preparation of DR table instrument
Material and equipment needed 4 3 2 1
- Proper positioning of patient 4 3 2 1
- Drapes aseptically and systematically 4 3 2 1
- Anticipate need of doctors who’s responsible during
Delivery process 4 3 2 1
- Notes the time of delivery 4 3 2 1
- Care of Post-Partum patient/ instrument used 4 3 2 1
(Includes identification of the following:
- Height of fundus 4 3 2 1
Conditions of fundus 4 3 2 1
- Assists during Episiotomy repair 4 3 2 1
10. Evaluate effectiveness of nursing action and identifies
remaining problems which still needs total care 4 3 2 1

III. ASSETS ( 20 % )

1. Abides with all institutional policies 4 3 2 1


2. Participate attentively and actively in all ward teaching
and learning activities 4 3 2 1
3. Accepts nursing responsibilities with interest
eagerness to work initiative, resourcefulness and creativity 4 3 2 1
4. Accepts constructive criticism and profit from it 4 3 2 1
5. Establish professionalism with co- students, patient,
significant others and other members of the health team. 4 3 2 1

Total: ________________

_____________________________ _____________________________
Students Signature Clinical Instructor Signature

Issue: 05 April 2006 Revision Code: 003

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