Cadiz City, Negros Occidental NAME OF S!"EN ############################# C$%N%CA$ AREA ####################### %NC$!S%&E "AE OF R$E E'PER%ENCE ############### (RA"E ############################### CLINICAL PERFORMANCE RATING SCALE: HOSPITAL BASED ER! OPD "n# $ARD% LE&EL I&% Dire'(ion: Place the actual score if the beha)ior*s+ill described ,as de-onstrated. %f it ,as not de-onstrated include re-ar+s in the space pro)ided. Be)"*ior+S,ill S'ore Re-"r,s D A %. SAFE AND ./ALIT0 N/RSING CARE S.C% A11lies ()e nursing 1ro'ess in ()e '"re of 1"(ien(s 2i() 1ro3le-s of nu(ri(ion "n# -e("3olis-! 1er'e1(ion "n# 'oor#in"(ion! "l(er"(ions in i--une res1onse "n# infe'(ion! 'ellul"r "3err"(ion "n# re)"3ili("(ion4 /./ Assess the client0s health status based on1 Nursing 2istory Measures )ital signs accurately Physical Assess-ent "iagnostic*$aboratory e3a-s / .4 Analyzes client0s data utilizing the appropriate theoretical fra-e,or+. /.5 "efines the nursing diagnosis /.6 Prioritizes the nursing diagnosis /.7 For-ulates plan of care. %dentifies (oals*Ob8ecti)es Specifies appropriate nursing inter)entions "efines e)aluation criteria /.9 %-ple-ents appropriate inter)entions 2ealth pro-oting inter)entions %llness pre)enting inter)entions Curati)e*restorati)e inter)entions Supporti)e biobeha)ioral inter)entions Rehabilitati)e inter)entions %nter)entions specific to the nursing diagnosis identified Obser)es principles for safety, pri)acy and co-fort ,hen pro)iding care. (i)es full attention to patient*client ,hen gi)ing care. Pro)ides nursing care based on the indi)idual0s needs 5 4 5 4 4 5 4 5 5 4 4 4 5 5 4 4 4 6 5 4 5 4 II4MANAGEMENT OF RESO/RCES! EN&IRONMENT AND E./IPMENT MRE% Adapts en)iron-ent to -a+e it conduci)e for healing*pleasing of the patient. 4 III4 HEALTH ED/CATION HE% Pro)ides appropriate health education and health teachings 4 I&4 LEGAL RESPONSIBILITIES LR% Maintains confidentiality of patient*client and staff. Safeguards the indi)idual0s rights to pri)acy Pre)ents and*or -anages proble-s related ,ith specific phase of the nurse : client relationship. 4 / / &4 PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD% De-ons(r"(es 1osi(i*e "((i(u#es 35: 7./ Obser)es bedside -anners and courtesies. 7.4 Respects client0s spirituality and cultural needs. / / 7.5 "e-onstrates honesty in reporting*recording data. 7.6 "e-onstrates co-passion, genuine concern for patient0s ,elfare, and caring not only for patient but also to the fa-ily*support syste-. 7.7 Presents self in a -anner that pro-otes the i-age of nursing. ;ell groo-ed Pleasant disposition 4
4 / / &I4 ./ALIT0 IMPRO&EMENT .I% E)aluates client0s response*outco-es of care based on criteria !ses feedbac+*clinical super)ision to i-pro)e nursing care. Sho,s ho, feelings*reactions can be -anaged to -aintain standards of care. !ses an updated re)ie, of literature in1 < "e)eloping the nursing care plan. < ;ard conference*Case presentation 5 4 4 4 &II4 ETHICO-MORAL RESPONSIBILITIES EMR% Dis1l"5s self #ire'(ion "n# self #is'i1line Reports for duty on ti-e. Sub-its re=uire-ents on ti-e. Finishes ,or+ on ti-e. Sho,s initiati)e in acti)ities. "e-onstrates effecti)e ti-e -anage-ent "e-onstrates honesty in reporting*recording data. / / / 4 4 4 &III4 RESEARCH Proposes possible solutions*options to proble-s*issues identified utilizing research studies 4 I64 RECORD MANAGEMENT RM% "e-onstrates accuracy and honesty in recording and reporting4 4 64 COMM/NICATION "e-onstrates therapeutic co--unication s+ills. %ntroduces self and addresses patients*clients, other indi)iduals as they prefer to be addressed. reats others ,ith respect regardless of bac+ground. 4 / / 6I4 COLLABORATION AND TEAM$OR7 S)o2s le"#ers)i1 in '"ring for ()e 1"(ien(s 35: Collaborates ,ith -e-bers of the health tea- in)ol)ed in client care %nitiates acti)ities or inter)entions to pro-ote*-aintain health of pre)ent illness. Supports the rights of other pro)iders to suggest alternati)es to the plan of care. 4 4 / TOTAL SCORE />> GRADE E./I&ALENT Co--ents1 ######################################################## Signature of Student1 ###################### Signature of eacher1 ##################### "ate of E)aluation1 ####################### CLINICAL PERFORMANCE E&AL/ATION GRADING S0STEM: 89 :;; < :4;; =; => < ?4>; 8? 8> < :4?> 9> 98 < ?4=> @@ 8: < :4>; 9; 9A < B @A @= < :4=> >> >8 < A @; @B < ?4;; BELO$ >> < > =9 =8 < ?4?> Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental NAME OF S!"EN ############################# C$%N%CA$ AREA ####################### %NC$!S%&E "AE OF R$E E'PER%ENCE ############### (RA"E ############################### CLINICAL PERFORMANCE RATING SCALE: HOSPITAL BASED OPD "n# $ARD% LE&EL III% Dire'(ion: Place the actual score if the beha)ior*s+ill described ,as de-onstrated. %f it ,as not de-onstrated include re-ar+s in the space pro)ided. Be)"*ior+S,ill S'ore Re-"r,s D A I4 SAFE AND ./ALIT0 N/RSING CARE S.C% A11lies ()e nursing 1ro'ess in ()e '"re of 1"(ien(s 2i() 1ro3le-s of nu(ri(ion "n# -e("3olis-! 1er'e1(ion "n# 'oor#in"(ion! "l(er"(ions in i--une res1onse "n# infe'(ion! 'ellul"r "3err"(ion "n# re)"3ili("(ion4 /./ Assess the client0s health status based on1 Nursing 2istory Measures )ital signs accurately Physical Assess-ent "iagnostic*$aboratory e3a-s / .4 Analyzes client0s data utilizing the appropriate theoretical fra-e,or+. /.5 "efines the nursing diagnosis /.6 Prioritizes the nursing diagnosis /.7 For-ulates plan of care. %dentifies (oals*Ob8ecti)es Specifies appropriate nursing inter)entions "efines e)aluation criteria /.9 %-ple-ents appropriate inter)entions 2ealth pro-oting inter)entions %llness pre)enting inter)entions Curati)e*restorati)e inter)entions Supporti)e biobeha)ioral inter)entions Rehabilitati)e inter)entions %nter)entions specific to the nursing diagnosis identified Obser)es principles for safety, pri)acy and co-fort ,hen pro)iding care. (i)es full attention to patient*client ,hen gi)ing care. Pro)ides nursing care based on the indi)idual0s needs 5 4 5 4 4 5 4 5 5 4 4 4 5 5 4 4 4 6 5 4 5 6 II4 HEALTH ED/CATION HE% Pro)ides appropriate health education and health teachings 4 III4 LEGAL RESPONSIBILITIES LR% Maintains confidentiality of patient*client and staff. Safeguards the indi)idual0s rights to pri)acy Pre)ents and*or -anages proble-s related ,ith specific phase of the nurse : client relationship. 4 / / I&4 PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD% De-ons(r"(es 1osi(i*e "((i(u#es 35: 7./ Obser)es bedside -anners and courtesies. 7.4 Respects client0s spirituality and cultural needs. 7.5 "e-onstrates honesty in reporting*recording data. / / 4 7.6 "e-onstrates co-passion, genuine concern for patient0s ,elfare, and caring not only for patient but also to the fa-ily*support syste-. 7.7 Presents self in a -anner that pro-otes the i-age of nursing. ;ell groo-ed Pleasant disposition
4 / / &4 ./ALIT0 IMPRO&EMENT .I% E)aluates client0s response*outco-es of care based on criteria !sing feedbac+*clinical super)ision to i-pro)e nursing care. Sho,s ho, feelings*reactions can be -anaged to -aintain standards of care. !ses an updated re)ie, of literature in1 < "e)eloping the nursing care plan. < ;ard conference*Case presentation 5 4 4 4 &I4 ETHICO-MORAL RESPONSIBILITIES EMR% Dis1l"5s self #ire'(ion "n# self #is'i1line Reports for duty on ti-e. Sub-its re=uire-ents on ti-e. Finishes ,or+ on ti-e. Sho,s initiati)e in acti)ities. "e-onstrates effecti)e ti-e -anage-ent "e-onstrates honesty in reporting*recording data. / / / 4 4 4 &II4 RESEARCH Proposes possible solutions*options to proble-s*issues identified utilizing research studies 4 &III4 RECORD MANAGEMENT RM% "e-onstrates accuracy and honesty in recording and reporting4 4 I64 COMM/NICATION "e-onstrates therapeutic co--unication s+ills. %ntroduces self and addresses patients*clients, other indi)iduals as they prefer to be addressed. reats others ,ith respect regardless of bac+ground. 4 / / 64 COLLABORATION AND TEAM$OR7 S)o2s le"#ers)i1 in '"ring for ()e 1"(ien(s 35: Collaborates ,ith -e-bers of the health tea- in)ol)ed in client care %nitiates acti)ities or inter)entions to pro-ote*-aintain health of pre)ent illness. Supports the rights of other pro)iders to suggest alternati)es to the plan of care. 4 4 / TOTAL SCORE />> GRADE E./I&ALENT Co--ents1 ######################################################## Signature of Student1 ###################### Signature of eacher1 ##################### "ate of E)aluation1 ####################### CLINICAL PERFORMANCE E&AL/ATION GRADING S0STEM: 89 :;; < :4;; =; => < ?4>; 8? 8> < :4?> 9> 98 < ?4=> @@ 8: < :4>; 9; 9A < B @A @= < :4=> >> >8 < A @; @B < ?4;; BELO$ >> < > =9 =8 < ?4?> Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental NAME OF S!"EN ############################# C$%N%CA$ AREA ####################### %NC$!S%&E "AE OF R$E E'PER%ENCE ############### (RA"E ############################### CLINICAL PERFORMANCE RATING SCALE: HOSPITAL BASED $ARD% LE&EL II% Dire'(ion: Place the actual score if the beha)ior*s+ill described ,as de-onstrated. %f it ,as not de-onstrated include re-ar+s in the space pro)ided. Be)"*ior+S,ill S'ore Re-"r,s D A I4 SAFE AND ./ALIT0 N/RSING CARE S.C% A11lies ()e nursing 1ro'ess in ()e '"re of 1"(ien(s 2i() 1ro3le-s of nu(ri(ion "n# -e("3olis-! 1er'e1(ion "n# 'oor#in"(ion! "l(er"(ions in i--une res1onse "n# infe'(ion! 'ellul"r "3err"(ion "n# re)"3ili("(ion4 /./ Assess the client0s health status based on1 Nursing 2istory Measures )ital signs accurately Physical Assess-ent "iagnostic*$aboratory e3a-s / .4 Analyzes client0s data utilizing the appropriate theoretical fra-e,or+. /.5 "efines the nursing diagnosis /.6 Prioritizes the nursing diagnosis /.7 For-ulates plan of care. %dentifies (oals*Ob8ecti)es Specifies appropriate nursing inter)entions "efines e)aluation criteria /.9 %-ple-ents appropriate inter)entions 2ealth pro-oting inter)entions %llness pre)enting inter)entions Curati)e*restorati)e inter)entions Supporti)e biobeha)ioral inter)entions Rehabilitati)e inter)entions %nter)entions specific to the nursing diagnosis identified Obser)es principles for safety, pri)acy and co-fort ,hen pro)iding care. (i)es full attention to patient*client ,hen gi)ing care. Pro)ides nursing care based on the indi)idual0s needs 5 4 5 4 4 5 4 5 5 4 4 4 5 5 4 4 4 6 5 4 5 6 II4 HEALTH ED/CATION HE% Pro)ides appropriate health education and health teachings 4 III4 LEGAL RESPONSIBILITIES LR% Maintains confidentiality of patient*client and staff. Safeguards the indi)idual0s rights to pri)acy Pre)ents and*or -anages proble-s related ,ith specific phase of the nurse : client relationship. 4 / / I&4 PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD% De-ons(r"(es 1osi(i*e "((i(u#es 35: 7./ Obser)es bedside -anners and courtesies. 7.4 Respects client0s spirituality and cultural needs. 7.5 "e-onstrates honesty in reporting*recording data. 7.6 "e-onstrates co-passion, genuine concern for patient0s ,elfare, / / 4
and caring not only for patient but also to the fa-ily*support syste-. 7.7 Presents self in a -anner that pro-otes the i-age of nursing. ;ell groo-ed Pleasant disposition 4 / / &4 ./ALIT0 IMPRO&EMENT .I% E)aluates client0s response*outco-es of care based on criteria !sing feedbac+*clinical super)ision to i-pro)e nursing care. Sho,s ho, feelings*reactions can be -anaged to -aintain standards of care. !ses an updated re)ie, of literature in1 < "e)eloping the nursing care plan. < ;ard conference*Case presentation 5 4 4 4 &I4 ETHICO-MORAL RESPONSIBILITIES EMR% Dis1l"5s self #ire'(ion "n# self #is'i1line Reports for duty on ti-e. Sub-its re=uire-ents on ti-e. Finishes ,or+ on ti-e. Sho,s initiati)e in acti)ities. "e-onstrates effecti)e ti-e -anage-ent "e-onstrates honesty in reporting*recording data. 5 5 / 4 4 4 &II4 COMM/NICATION "e-onstrates therapeutic co--unication s+ills. %ntroduces self and addresses patients*clients, other indi)iduals as they prefer to be addressed. reats others ,ith respect regardless of bac+ground. 4 / / &III4 COLLABORATION AND TEAM$OR7 S)o2s le"#ers)i1 in '"ring for ()e 1"(ien(s 35: Collaborates ,ith -e-bers of the health tea- in)ol)ed in client care %nitiates acti)ities or inter)entions to pro-ote*-aintain health of pre)ent illness. Supports the rights of other pro)iders to suggest alternati)es to the plan of care. 4 4 / TOTAL SCORE />> GRADE E./I&ALENT Co--ents1 ######################################################## Signature of Student1 ###################### Signature of eacher1 ##################### "ate of E)aluation1 ####################### CLINICAL PERFORMANCE E&AL/ATION GRADING S0STEM: 89 :;; < :4;; =; => < ?4>; 8? 8> < :4?> 9> 98 < ?4=> @@ 8: < :4>; 9; 9A < B @A @= < :4=> >> >8 < A @; @B < ?4;; BELO$ >> < > =9 =8 < ?4?>
Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental LE&EL III "n# LE&EL I& S/MMAR0 PERFORMANCE E&AL/ATION ACHIE&ING INTRA-OPERATI&E CARE COMPETENC0 In A''or#"n'e 2i() PRC Bo"r# of Nursing Me-or"n#u- No4 ;: Series of ?;;8 Signature o)er Printed Na-e of Student1 ##################################### INTRA-OPERATI&E CARE COMPETENCIES DESIRED RATING : ST RLE ? ND RLE B RD RLE A&ERAGE RATING I4 SAFE AND ./ALIT0 N/RSING CARE S.C% /. !tilizes the nursing process in the care of OR client. Obtains co-prehensi)e client0s infor-ation by chec+ing co-plete acco-plish-ent of the preoperati)e chec+list*client0s chart. 6 %dentifies priority needs of the client at the Operating Roo-. 6 Pro)ides needed nursing inter)entions based on identified needs. 6 Monitor client0s response to surgery. 4 4. Pro-otes safety and co-fort of patient inside the OR. 4 5. Perfor-s functions of the scrub nurse. Perfor-s surgical scrub correctly. 6 ;ears sterile go,ns and glo)es aseptically. 4 Prepares surgical instru-ents, sponges, sutures, and other supplies in functional arrange-ent. 4 2ands instru-ents, sponges, sutures, and other needed -aterials according to surgeon0s preference. 4 Perfor-s surgical count accurately. 4 6. Perfor-s the functions of the circulating nurse. Anticipates the needs of the surgical tea-. 4 Sets up the OR roo- and needed e=uip-ent. 4 Recei)es client for surgery*endorses client post< operati)ely. 4 Assists in s+in preparation and draping of client. 4 7. Ad-inisters -edications and other health therapeutics safely. 4 II4 MANAGEMENT OF RESO/RCES AND EN&IRONMENT MRE% /. Organizes ,or+ load to facilitate ti-ely patient care. 6 4. !tilizes ade=uate and appropriate resources to support the OR ea-. 4 5. Ensures functionality of OR resources. 4 6. Maintains a safe en)iron-ent at the OR by obser)ing the principles of asepsis. 4 III4 HEALTH ED/CATION HE% /. %-ple-ents appropriate health education acti)ities to client based on needs assess-ent. 4 I&4 LEGAL RESPONSIBILITIES LR% /. Adheres to legal and institutional protocols regarding infor-ed consent. 4 &4 ETHICO-MORAL RESPONSIBILITIES EMR% /. Respects the rights of the OR client. 4 4. Accepts responsibility and accountability for o,n decisions and actions as an OR nurse. 4 &I4 PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD% /. Perfor-s OR functions according to professional standards. 6 4. Possesses positi)e attitude to,ards learning surgical and OR<related +no,ledge and s+ills. 4 &II4 ./ALIT0 IMPRO&EMENT .I% /. Participates in =uality i-pro)e-ent acti)ities related to infection control and successful OR operations. 4 4. %dentifies and reports )ariances in sterility and other OR acti)ities. 4 &III4 RESEARCH R% /. "isse-inates results of OR<related research findings to clinical group and other -e-bers of the OR tea- as appropriate. 4 I64 RECORD MANAGEMENT RM% /. Maintain accurate and updated docu-entation of patient care. 4 64 COMM/NICATION Co--% /. Establishes rapport ,ith patients, significant others and -e-bers of the health tea-. / 4. !ses appropriate infor-ation -echanis-s to facilitate co--unication inside the OR and ,ith other depart-ents in the hospital. 4 6I4 COLLABORATION AND TEAM$OR7 CTM% /. Collaborates plan of care ,ith other -e-bers of the health tea-. 4 TOTAL SCORE => ;hen (raded R$E0s ;ere Perfor-ed ?Specify Acade-ic @ear and Se-esterA First (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC Second (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC hird (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC &erified rue and Correct1 ?Signature o)er Printed Na-esA #################################### Clinical Coordinator $icense Nu-ber1 ################# &alidity "ate1 ########### #################################### Acade-ic @ear (raduated ############################### "EAN $icense Nu-ber1 ################# &alidity "ate1 ###########
Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental LE&EL III "n# LE&EL I&
S/MMAR0 PERFORMANCE E&AL/ATION ACHIE&ING INTRA-PARTAL CARE COMPETENC0 In A''or#"n'e 2i() PRC Bo"r# of Nursing Me-or"n#u- No4 ;: Series of ?;;8 Signature o)er Printed Na-e of Student1 ##################################### INTRA-PARTAL COMPETENCIES DESIRED RATING ACT/AL RATING I4 SAFE AND ./ALIT0 N/RSING CARE S.C% /. Obtains obstetrical history including parity, gra)ida score, $MP, E"C, AO(, BO; onset of true labor. 4. Chec+s )ital signs. 5. Conducts physical e3a-ination. 6. Perfor-s $eopold Maneu)er. 7. Chec+s Fetal 2eart Rate and Fundic 2eight. 9. Monitor progress of labor*uterine contractions as to1 Fre=uency "uration %ntensity %nter)al C. Obser)es for the ti-ely rupture of -e-brane. D. Coaches -other on process of labor. 6 / 4 4 4 / / / / / 4 PERFORMS F/NCTIONS D/RING ACT/AL LABOR /. ransports clients safely ,hile pro)iding pri)acy. 4. Places -other in lithoto-y position. 5. Perfor-s perineal care using sterile techni=ue correctly. 6. Perfor-s proper hand scrub. 7. ;ears go,n and glo)es according to hospital policy. 9. Perfor-s RitgenEs Maneu)er safely. C. Coaches -other on breathing and pushing techni=ues. D. "eli)ers baby and placenta carefully. Chec+s and -anages cord recoil correctly. Cla-ps and cut the cord correctly. %dentify signs of placental separation. Chec+s the characteristic*co-pleteness of the placenta. F. Assesses a-ount of blood loss ?Nor-al1 G7>> ccA. />. E-ploys inter)entions to achie)e and -aintain a ,ell contracted uterus to pre)ent*control he-orrhage. !terine -assage Correct ad-inistration of o3ytocin Cold co-press //. Assesses presence and degree of laceration. /4. Assist in episiorrhaphy. /5. Chec+s size, consistency and location of uterus. /6. Perfor-s perineal care and applies pad correctly. /7. Pro)ides e-otional support to the -other throughout labor and deli)ery. /9. E)aluates patient0s condition and records pertinent data accordingly. /C. Prepares patient for transfer to reco)ery roo-*,ard. / / / / / 4 / / / / / 4 / / / / / / / / 4 4 5 5 5 II4 MANAGEMENT OF RESO/RCES! EN&IRONMENT AND E./IPMENT MRE% /. Prepares roo-, instru-ents and e=uip-ent needed. Sterile drape Sterile instru-ents and e=uip-ent Hforceps, scissors, bulb syringe, gauze, suture, needle holder, catheter ?optionalAI. Jelly pad "isinfectant 4. Perfor-s sterilization procedure. 5. Maintains ade=uacy of supplies as the deli)ery progresses. 6. Maintains orderliness of the sterile table. 7. Obser)es precautionary -easures related to use of electrical e=uip-ent. 9. Ensures a =uite en)iron-ent. C. !ses supplies diligently. D. Perfor-s after care of the -aterials and e=uip-ents used. F. Ensures proper disposal of hospital ,aste including blood and other fluids. / / / / / / / / / / / / III4 HEALTH ED/CATION HE% /. eaches client on basic preparation during labor and deli)ery ?can be done in the labor room). 4. Coaches0 client on breathing*bearing do,n techni=ue. 5. "e-onstrates proper Klatch<onL breastfeeding techni=ue ?done post-partum periodA. 6. (i)es instruction to parents regarding infant care before discharge ?done post-partum periodA. 7. Pro)ides discharge instructions as to feeding, bathing, ad-inistration of ordered -edications, appoint-ent dates for post natal and ,ell baby chec+<up ?done post-partum periodA. 9. Responds to =uestions of clients and relati)es regarding e3pectations. / 4 / / / / I&4 LEGAL RESPONSIBILITIES LR% /. Secures infor-ed consent in all procedures related to labor and deli)ery. 4. Reports accurately and honestly the gender, ti-e of deli)ery of the baby and placenta. 5. Ensures proper identification of the -other and ne,born. 6. "ocu-ents all pertinent data correctly and co-pletely. / 4 4 / &4 ETHICO-MORAL RESPONSIBILITIES EMR% /. Respects the religious, cultural, and ethnic practices of the fa-ily of the ,o-an in labor and deli)ery. 4. Pro-otes e-otional security by supporting needs. 5. Ensures pri)acy and confidentiality. / / / &I4 PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD% /. !pdates oneself ,ith the latest trends and de)elop-ent in labor and deli)ery. 4. Pro8ects a professional i-age of a deli)ery roo- nurse. 5. Accepts criticis-s and reco--endations. 6. Perfor-s functions according to standards. / / / / &II4 ./ALIT0 IMPRO&EMENT .I% (preferably done during post conferences) /. %dentifies de)iation of practice fro- the standards. 4. Participates in audit practices in the deli)ery roo-*lying in. 5. Reco--ends correcti)e and pre)enti)e -easures for the identified de)iations. / / / &III4 RESEARCH R% (preferably done during post conferences) /. %dentifies researchable proble-s related to labor and deli)ery. 4. !tilize findings of research studies in intra<partal care. 4 4 I64 RECORDS MANAGEMENT RM% /. "ocu-ents accurately rele)ant data about client. 4. Maintains and organized syste- of filing and +eeping records of the client. / / 64 COMM/NICATION Co--% /. !tilizes appropriately all for-s of co--unicationE )erbal, non<)erbal, electronic. 4. %nfor- client0s significant others of the progress of labor and deli)ery. 5. $istens attenti)ely to clients and fa-ilies =ueries and re=uests. / / / 6I4 COLLABORATION AND TEAM$OR7 CT$% /. Functions effecti)ely as a tea- player in the deli)ery roo-*lying in. 4. Co--unicates the progress of labor*deli)ery to significant others. 5. Establishes collaborati)e relationships ,ith -e-bers of the health tea- and fa-ily -e-bers. / / / TOTAL SCORE :;; ;hen (raded R$E0s ;ere Perfor-ed ?Specify Acade-ic @ear and Se-esterA First (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC Second (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC hird (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC &erified rue and Correct1 ?Signature o)er Printed Na-esA ################################ Clinical Coordinator $icense Nu-ber1 ################# &alidity "ate1 ########### ############################### Acade-ic @ear (raduated ############################### "EAN $icense Nu-ber1 ################# &alidity "ate1###########
Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental LE&EL III "n# LE&EL I& S/MMAR0 PERFORMANCE E&AL/ATION ACHIE&ING IMMEDIATE CARE OF THE NE$BORN COMPETENC0 In A''or#"n'e 2i() PRC Bo"r# of Nursing Me-or"n#u- No4 ;: Series of ?;;8 Signature o)er Printed Na-e of Student1 ##################################### NE$BORN COMPETENCIES DESIRED RATING ACT/AL RATING I4 SAFE AND ./ALIT0 N/RSING CARE S.C% /. Establishes and -aintain patent air,ay. 4. Puts the ne,born in rendelenburg Position. 5. Suctions -outh and nose of the ne,born gently. 6. "ries ne,born and ,raps ,ar-ly. Places under droplight as needed 7. Perfor-s and interpret AP(AR scoring correctly. %--ediately after deli)ery After 7 -inutes 9. Ensures proper identification of ne,born ?na-e tag1 na-e of -other, date and ti-e of deli)ery, gender and na-e of attending physicianA. C. Perfor-s physical assess-ent including anthropo-etric -easure-ents including ,eight, height, head, chest, abdo-inal circu-ference. D. a+es )ital signs ?te-perature, per rectu- to chec+ patencyA. F. (i)es oil*,ater and soap bath according to institutional policy. /> $atches ne,born to the -other0s breast i--ediately after birth. //. Applies CRE"E0S prophyla3is on the eyes. /4. Perfor-s cord dressing aseptically. "isinfects area properly according to hospital policy. Cla-ps and cuts cord / inch fro- the abdo-en. Chec+s for the presence of 4 arteries and / )ein. "resses cord aseptically according to hospital policy. /5. Ad-inisters &it. J ?/ -g*MA %nto the lateral anterior thigh or )astus lateralis. /6. Jeep baby ,rapped ,ar-ly under floor la-p or beside -other according to institutional policy until discharge. /7. Records pertinent obser)ations and nursing care done. /9. Reports any signs of de)iation*abnor-ality to the pediatrician. 5 / 4 / 4 4 4 6 / / / / / / / / / / / / 4 4 / II4 MANAGEMENT OF RESO/RCES! EN&IRONMENT AND E./IPMENT MRE% /. Prepares instru-ents and e=uip-ents needed. Suction bulb, cord cla-p, gauze, cotton balls, disinfectant, blan+et, droplight, &ita-in J, anti-icrobial ophthal-ic oint-ent. 4. Ensures use of sterile e=uip-ent during i--ediate care of the ne,born. 5. Maintain ade=uacy of supplies as ne,born care is rendered. 6. Maintains orderliness of the ,or+ing area. 7. Obser)es precautionary -easures related to use of electrical e=uip-ent. 9. Ensures a ,ar- and =uiet en)iron-ent. C. !ses of supplies diligently. D. Ensures proper disposal of hospital ,aste. 6 / / / / / / / III4 HEALTH ED/CATION HE% /. Pro)ides instructions to the -other on daily cord care and pre)ention of cord infection. 4. Pro)ides discharge instructions to the -other on ,hen to e3pect cord to fall off or to report signs of cord infection. 5. Pro)ides infor-ation regarding ne,born screening, i--unization, feeding, etc. 6. Responds to =uestions of -other and relati)es regarding e3pectations. 4 / 4 / I&4 LEGAL RESPONSIBILITIES LR% /. %dentifies ne,born by co-paring %" band ,ith data in the chart. 4. "ocu-ents all pertinent data correctly and co-pletely. 5. Reports accurately any de)iations*abnor-al findings and nursing inter)entions rendered. 6. Ensures the birth certificate and other ci)il registration for-s are acco-plished*filled out according to institutional policy. 7. Perfor-s foot printing according to hospital policy. 4 / / 4 / &4 ETHICO-MORAL RESPONSIBIITIES EMR% /. Respects the religious, cultural and ethnic practices of the fa-ily of the ne,born. 4. Maintains pri)acy and confidentiality of findings of / / assess-ents. &I4 PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD% /. !pdates oneself ,ith the latest trends and de)elop-ents in ne,born care. 4. Pro8ects a professional i-age of the pediatric nurse. 5. Accepts criticis-s and reco--endations. 6. Perfor-s functions according to standards. / / / / &II4 ./ALIT0 IMPRO&EMENT .I% /. %dentifies de)iation of practice fro- the standards. 4. Participates ?,hene)er possibleA in audit practices in the nursery. 5. Reco--ends correcti)e and pre)enti)e -easures for the identified de)iations. / / / &III4 RESEARCH R% /. %dentifies researchable proble-s related to i--ediate care of ne,born. 4. !tilizes findings of research studies in the i--ediate care of the ne,born. 4 4 I64 RECORDS MANAGEMENT RM% /. "ocu-ents accurately rele)ant data about ne,born. 4. Maintains an organized syste- of filing and record +eeping. / / 64 COMM/NICATION Co--% /. !tilizes appropriately all for-s of co--unicationE )erbal, non<)erbal, electronic. 4. Maintains an open line co--unication ,ith the -other and other fa-ily -e-bers. 5. %nfor-s -other of rele)ant infor-ation about ne,born. 6. $istens attenti)ely to =ueries and re=uests of -other and fa-ily -e-bers. / / / / 6I4 COLLABORATION AND TEAM$OR7 CT$% /. Functions effecti)ely as a tea- player in the nursery. 4. Co--unicates findings of assess-ent to all concerned. 5. Establishes a collaborati)e relationship ,ith -e-bers of the health tea- and fa-ily of the ne,born. / / / TOTAL SCORE @; ;hen (raded R$E0s ;ere Perfor-ed ?Specify Acade-ic @ear and Se-esterA First (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC Second (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC hird (raded R$E 1 A'"#e-i' 0e"r CCCCCCCC : s( Se-4 CCC ? n# Se-4 CCC Su--er CCCC Clinical %nstructor 1 N"-e CCCCCCCCCCCCCCCCCCCCCCC Sign"(ure CCCCCCCCCCCCCCCCCC Li'ense Nu-3er: CCCCCCCCCCCCC &"li#i(5: CCCCCCCCCCCCCCCCCCC &erified rue and Correct1 ?Signature o)er Printed Na-esA #################################### Clinical Coordinator $icense Nu-ber1 ################# &alidity"ate1########### ###################### Acade-ic @ear (raduated ############################# "EAN $icense Nu-ber1 ################# &alidity "ate1 ##########
Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental NCM 107 - B / INTENSIVE NURSING PRACTICUM (INP) PERFORMANCE RATING SCALE IN PRACTICING HEAD NURSING(PHN) NAME: _____________________________________________________YR. & SECTION: ___________ DATE OF EXPOSURE: _________________________AREA OF EXPOSURE:____________________ BEAVIOR D!"#$!% A&'()* REMAR+S S&,$! I. SAFE AND -UA.ITY CARE Categorizes degree of patient care required Identifies priority problems of patterns. Transmits plan of care to the rest of nursing staff through: 1. Verbal reminders 2. Karde !. "ndorsements Coordinates plans #ith the medical team$ dietary department$ physical therapist$ social #or%ers etc. Interprets role to patients$ families$ nursing staff$ and other hospital personnel. "nsures that ne# doctor&s orders are noted and carried out. 'emonstrates nursing procedures Concerning diagnostic #or% ups$ super(ises: )reparation and*or sending of patients to diagnostic units. Collection and sending of specimen to appropriate places. 10 10 10 10 10 10
10
10 10 10 10 10 II. RECORDS MANAGEMENT 1. Chec%s records Karde )rogress notes 'iet lists +lo# sheets ,ard report Communication boo% 10 10 10 10 10 10 III. -UA.ITY IMPROVEMENT -a%es rounds to obser(e effecti(eness of care. .ffers assistance to staff. 'emonstrates competence and confidence in performing nursing actions. 'isplays competence in the use of nursing process. 1/.,rites anecdotal reports 0at least once1. This should include: 2n ob3ecti(e description of the e(ent*acti(ity being obser(ed. 2nalysis of e(ent*acti(ity 10 10 10 10 10 IV. .EGA. RESPONSIBI.ITY 'emonstrates gender sensiti(ity in patient care. "nsures patient&s safety$ comfort and pri(acy. Interprets hospital and #ard policies to students$ patients*families. 4eads memos and transmits them to staff as necessary. +ollo#s policies and regulations of the: 5ospital*,ard College of 6ursing 10 10 / / 10 10 V. COMMUNICATION 17. "stablishes clear communications #ith nursing and other disciplines regarding patient care. Confers #ith the physician regarding the diagnosis*response*non8response to treatment*prognosis. 10 10 VI. CO..ABORATION AND TEAM0OR+ Initiates referral$ as necessary. 10 9oins the physician&s rounds. Communicates #ith headnurse*nursing personnel regarding patient care 0e.g.$ endorsements$ nursing rounds1. Confers #ith the other members of he health team. 1:. Considers the follo#ing in delegating functions*tas%s: 2bilities and s%ills "(aluation of completed tas%s 10 10 10 10 10 VII. EA.T EDUCATION )articipates in patient*#atcher orientation*education.. Conducts nursing rounds*bedside conference 0at least once1 / 10 VIII.MANAGEMENT OF ENVIRONMENT1 RESOURCES AND E-UIPMENT "nsures the follo#ing: Cleanliness of the area 2dequacy of appropriate: a. ;upplies b. <inens 2dequate functioning equipments Chec%s attendance of personnel and ma%es the necessary ad3ustments. )lans schedule of .++ duties*(acation at least t#o #ee%s in ad(ance 10 10 10 10 10 IX.RESEARC Conducts staff de(elopment acti(ities: i.e. sharing of current$ rele(ant literatures and research findings #ith the staff. 10 2ccepts constructi(e criticisms and ma%es appropriate changes. =i(es constructi(e criticisms 'emonstrates self8direction 'iscerns bioethical implications #hen ma%ing decisions. ;ho#s compassion and commitment to the #elfare of the indi(idual client and family. 'emonstrates honesty in data gathering$ problem identification$ implementing inter(entions$ and e(aluating outcomes. 'oes the right thing despite the consequences. ;tri(es for continuous impro(ement of self considering a holistic perspecti(e )ursues clients goals and ob3ecti(es in life. 'emonstrates critical thin%ing in (aried situations. 'emonstrates situational fleibility and adaptability. 2(ails self of opportunities for learning 10 10 10 10 10 10 10 10 10 10 10 10 XI. ETICO-MORA. RESPONSIBI.ITY 2ccepts the transcultural differences in health status among social classes and bet#een cultural groups. Integrates culture8based practices #ith professional modes of inter(entions. 4ecognizes talents$ capabilities$ and potential of the +ilipinos. ;er(es the +ilipino people especially the poor and the marginalized group. Considers the multi8ethnicity of the +ilipino people. 10 10 10 10 10 ;ets ob3ecti(es to direct acti(ities. >tilizes a time plan for organization of acti(ities*efficiency and economy of time and energy. -aintains harmonious relationship #ith #ard personnel. 4eports to #or% punctually. 6otifies #ard if unable to report for duty. 2ppears neat and #ell groomed. ;ubmits requirements on time. 'isplays consistency of one&s beliefs and actions. 10 10 10 10 10 10 10 / / M#2#3(3 S&,$!: 451 M)6#3(3 S&,$!: 47/ 1.00 470 - 47/ 8.8/ 49: - 4/9 1.8/ 479 - 47: 8./0 495 - 497 1./0 447 - 475 8.7/ 457 - 498 1.7/ 448 - 447 5.00 451 - 454 8.00 4/4 - 441 Comments: ???????????????????????????????????????????????????????? ;ignature of ;tudent: ?????????????????????? ;ignature of Teacher: ????????????????????? 'ate of "(aluation: ???????????????????????
Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental NCM 107 - B / INTENSIVE NURSING PRACTICUM (INP) PERFORMANCE RATING SCALE IN PRACTICING CLINICAL INSTRUCTOR(PCI) NAME: _____________________________________________________YR. & SECTION: ___________ DATE OF EXPOSURE: _________________________AREA OF EXPOSURE:____________________ BEAVIOR D!"#$!% A&'()* S&,$! REMAR+S I. SAFE AND -UA.ITY CARE Categorizes degree of patient care required Identifies priority problems of patterns. Transmits plan of care to the rest of nursing students and staff through: 1. Verbal reminders 2. Karde 10 10 10 10 10 10 !. "ndorsements Coordinates plans #ith the medical team$ dietary department$ physical therapist$ social #or%ers etc. Interprets role to patients$ families$ nursing staff$ and other hospital personnel. "nsures that ne# doctor&s orders are noted and carried out. 'emonstrates nursing procedures Concerning diagnostic #or% ups$ super(ises: )reparation and*or sending of patients to diagnostic units. Collection and sending of specimen to appropriate places.
10
10 10 10 10 10 II. RECORDS MANAGEMENT 2. Chec%s records Karde )rogress notes 'iet lists +lo# sheets ,ard report Communication boo% 10 10 10 10 10 10 III. -UA.ITY IMPROVEMENT -a%es rounds to obser(e effecti(eness of care. .ffers assistance to staff. 'emonstrates competence and confidence in performing nursing actions. 'isplays competence in the use of nursing process. 1/.,rites anecdotal reports 0at least once1. This should include: 2n ob3ecti(e description of the e(ent*acti(ity being obser(ed. 2nalysis of e(ent*acti(ity 10 10 10 10 10 IV. .EGA. RESPONSIBI.ITY 'emonstrates gender sensiti(ity in patient care. "nsures patient&s safety$ comfort and pri(acy. Interprets hospital and #ard policies to students$ patients*families. 4eads memos and transmits them to staff as necessary. +ollo#s policies and regulations of the: 5ospital*,ard College of 6ursing 10 10 / / 10 10 V. COMMUNICATION 17. "stablishes clear communications #ith nursing and other disciplines regarding patient care. Confers #ith the physician regarding the diagnosis*response*non8response to treatment*prognosis. 10 10 VI. CO..ABORATION AND TEAM0OR+ Initiates referral$ as necessary. 9oins the physician&s rounds. Communicates #ith headnurse*nursing personnel regarding patient care 0e.g.$ endorsements$ nursing rounds1. Confers #ith the other members of he health team. 1:. Considers the follo#ing in delegating functions*tas%s: 2bilities and s%ills "(aluation of completed tas%s 10 10 10 10 10 10 VII. EA.T EDUCATION )articipates in patient*#atcher orientation*education.. Conducts nursing rounds*bedside conference 0at least once1 / 10 VIII.MANAGEMENT OF ENVIRONMENT1 RESOURCES AND E-UIPMENT "nsures the follo#ing: Cleanliness of the area 2dequacy of appropriate: c. ;upplies d. <inens 2dequate functioning equipments Chec%s attendance of personnel and ma%es the necessary ad3ustments. )lans schedule of .++ duties*(acation at least t#o #ee%s in ad(ance 10 10 10 10 10 IX.RESEARC Conducts staff de(elopment acti(ities: i.e. sharing of current$ rele(ant literatures and research findings #ith the staff. 10 2ccepts constructi(e criticisms and ma%es appropriate changes. =i(es constructi(e criticisms 'emonstrates self8direction 'iscerns bioethical implications #hen ma%ing decisions. ;ho#s compassion and commitment to the #elfare of the indi(idual client and family. 'emonstrates honesty in data gathering$ problem identification$ implementing inter(entions$ and e(aluating outcomes. 'oes the right thing despite the consequences. ;tri(es for continuous impro(ement of self considering a holistic perspecti(e )ursues clients goals and ob3ecti(es in life. 'emonstrates critical thin%ing in (aried situations. 'emonstrates situational fleibility and adaptability. 2(ails self of opportunities for learning 10 10 10 10 10 10 10 10 10 10 10 10 XI. ETICO-MORA. RESPONSIBI.ITY 2ccepts the transcultural differences in health status among social classes and bet#een cultural groups. Integrates culture8based practices #ith professional modes of inter(entions. 4ecognizes talents$ capabilities$ and potential of the +ilipinos. ;er(es the +ilipino people especially the poor and the marginalized group. Considers the multi8ethnicity of the +ilipino people. ;ets ob3ecti(es to direct acti(ities. >tilizes a time plan for organization of acti(ities*efficiency and economy of time and energy. -aintains harmonious relationship #ith #ard personnel. 4eports to #or% punctually. 6otifies #ard if unable to report for duty. 2ppears neat and #ell groomed. 10 10 10 10 10 10 10 10 10 10 10 10 / ;ubmits requirements on time. 'isplays consistency of one&s beliefs and actions. / M#2#3(3 S&,$!: 451 M)6#3(3 S&,$!: 47/ 1.00 470 - 47/ 8.8/ 49: - 4/9 1.8/ 479 - 47: 8./0 495 - 497 1./0 447 - 475 8.7/ 457 - 498 1.7/ 448 - 447 5.00 451 - 454 8.00 4/4 - 441 Comments: ???????????????????????????????????????????????????????? ;ignature of ;tudent: ?????????????????????? ;ignature of Teacher: ????????????????????? 'ate of "(aluation: ??????????????????????? Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental NAME OF S!"EN ############################ C$%N%CA$ AREA ####################### %NC$!S%&E "AE OF E'PER%ENCE ############### (RA"E ############################### CLINICAL PERFORMANCE EVALUATION CHECKLIST Postprtu! Cre of Mot"er n# Ne$%orn in Nor!l Stte COMPETENC&'SKILL (ESIRE ( SCO RE REMARKS I) SAFE AN( *UALIT& NURSIN+ CARE ,S*C- .) Utili/es t"e nursing pro0ess in t"e 0re of $o!en n# t"eir ne$%orn in t"e postprtu! perio# ,.1 points- )* Assesses the client+s health status based on, a) history -ndings 2 obstetrical history 2 course during labor 2 course during deli.ery 2 Apgar Scoring b) physical 2 uterine contraction 2 .aginal bleeding 2 physiologic adaptation 2 .ital signs 2 ne/born re0e1es 2 re.ie/ of syste2s c) psychological e1a2 3psychological adaptation4 d) results of diagnostic e1a2inations e) socio 5 econo2ic and cultural factors f) drug studies )6 "e-nes physiological and psychological nursing diagnosis in the follo/ing areas, a) For !ot"er3 health perception7health 2anage2ent, Nutrition72etabolic, eli2ination, acti.ity 5 e1ercise, sleep 5 rest, cogniti.e 5 perceptual, self 5 perception, self 5 concept, se1uality 5 reproducti.e, coping 5 stress, breastfeeding proble2s) b) For ne$%orn3 o1ygenation, ther2oregulation, potential for infection, parenting proble2s) 6)8 Prioritizes nursing diagnosis 6)9 !tilizing appropriate technology and i2ple2ents /ith the Mother and signi-cant others nursing actions based on the NCP, 369 points4 a) pre.enting co2plications of deli.ery 3he2orrhage, infection, hypother2ia, aspiration4 b) pro.iding proper nutrition 3postpartu2 diet4 c) pro2oting hygiene : co2fort in, ; bathing ne/born ; perineal care ; /ound care ; cord care ; breast hygiene d) pro2oting eli2ination e) perfor2ing postpartu2 e1cercises 3<E(A$ e1ercise, chin to chest, =nee to chest, /al=ing4 f) pro2oting rest and sleep 3sleep 5 /a=e pattern of ne/borns, 2aternal fatigue4 g) enhancing 2aternal, paternal and fa2ily adaptation ") postpartu2 chec= 5 ups i) 2a=ing decisions for fertility control 4) resu2ption of se1ual acti.ities 5) understanding ne/born responses 6 . . . . . . . . . 6 6 6 6 7 1 6 6 . . . . . 6 6 6 6 6 . 6 . . II) MANA+EMENT OF RESOURCES8 ENVIRONMENT AN( E*UIPMENT ,MRE- a) !tilizing appropriate technology and other resources in deli.ery of care 6 III) HEALTH E(UCATION ,HE- a) (i.es health teachings for the 2others and signi-cant others in ne/born care 6 IV) LE+AL RESPONSI9ILITIES ,LR- )Pro.ides pri.acy, co2fort and safety at all ti2es) 6 V) ETHICO-MORAL RESPONSI9IITIES ,EMR- a)Sho/s respect for di>erences in postpartu2 care practices b)Sho/s consideration for the 2other+s, ne/born and signi-cant other+s responses to inter.entions 6 6 VI) PERSONAL AN( PROFESSIONAL (EVELOPMENT ,PP(- a)!tilizes7re?uests for super.ision /hen needed b)Positi.ely accepts corrections and 2odi-es actions7inter.entions based on corrections) c)E.aluates o/n nursing perfor2ance based on certain standards 6 . . VII) *UALIT& IMPROVEMENT ,*I- a) Monitors7e.aluates client+s response7outco2es of care) 6 VIII) RESEARCH ,R- !ses updated re.ie/ of literature and research studies to, a) discuss current trends and issues in the care of the postpartu2 client and her ne/born) 6 I:) RECOR(S MANA+EMENT ,RM- a) "e2onstrates accuracy and honesty in recording and reporting signi-cant -ndings, nursing diagnosis and inter.entions 6 :) COMMUNICATION ,Co!- a) %ntroduces self and addresses client using preferred titles of respect
. :I) COLLA9ORATION AN( TEAM;ORK ,CT;- (e!onstrtes le#ers"ip'reltes e<e0ti=el> $' ot"ers in $or5 a) %denti-es role in a tea2 approach in health pro2otion and 2aintenance) b) Collaborates /ith health tea2 2e2bers in pro.iding total patient care) c) ti2ely referrals . . 6
TOTAL ?@ Stu#entAs Signture BBBBBBBBBBBBBBBBB C)IAs Signture BBBBBBBBBBBBBBBBB (te of E=lution BBBBBBBBBBBBBBBBBB NCM .CC C$%N%CA$ PERFORMANCE E&A$!A%ON (RA"%N( S@SEM Postpartu2 Care of a Mother and Ne/born in a Nor2al State AB 5 AC D *)E A6 5 A9 D *)6B CF 5 A* D *)B CC 5 CG D *)AB C8 5 CB D 6)E CE 5 C6 D 6)6B BA 5 BF D 6)B B9 5 BC D 6)AB B* 5 B8 D 8)E 9F 5 BE D 9)E H 9F D B Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental NAME OF S!"EN ############################ C$%N%CA$ AREA ####################### %NC$!S%&E "AE OF E'PER%ENCE ######################(RA"E ############################### PERFORMANCE E&AL/ATION CHEC7LIST COMM/NIT0 HEALTH N/RSING% BEHA&IOR+S7ILL Desire# S'ore Re-"r,s lI 4 SAFE AND ./ALIT0 N/RSING CARE S.C% :4: For-ulates initial data base on the fa-ily. 1.1.1 Perfor-s physical e3a-ination correctly and ,ith confidence. 1.1.2 Correlates PE findings ,ith other assess-ent data. 1.1.3 "iscri-inates bet,een nor-al and abnor-al findings. 1.1.4 !tilizes cues that support*are representati)e of the proble-. 1.1.5 Categorizes infor-ation*cues that reflect e3planations*inferences about the fa-ily0s health status and causes*reasons for these conditions. :4? %dentifies fa-ily nursing proble-s*diagnoses in a syste-atic and logical -anner. 1.2.1 All e3isting proble-s are identified and reported. 1.2.2 Proble-s reflect the bloc+s*barriers to the fa-ily0s assu-ption of the fa-ily health tas+. 1.2.3 Assess-ent done*shared ,ith the fa-ily. :4B Prioritizes fa-ily nursing proble-s*diagnoses. :4A For-ulates a fa-ily care plan ,ith the fa-ily. 1.4.1 Selects appropriate nursing actions. 1.4.2 "esigns a ti-e plan for action selected.. 1.4.3 !tilizes a)ailable physical and professional resources. ? :; :; :; :; :; :; :; :; > :; :; :; :; II4 MANAGEMENT OF RESO/RCES! EN&IRONMENT AND E./IPMENT MRE% !tilizes a)ailable physical and professional resources. Anticipates needs for future care. :; :; III4 HEALTH ED/CATION HE% 4 He"l() (e"')ing (o in#i*i#u"l "n# f"-il5 -e-3ers "s 'lien(s
%dentifies health infor-ation needs of indi)idual and fa-ily. "e)elops plan for health teaching based on identified needs and characteristics of client*fa-ily. %-ple-ents plan for health teaching. a.!ses language understandable to client*fa-ily. b.!ses e3isting and*or prepares appropriate and rele)ant teaching -aterials. E)aluates results of health teaching. > > ? ? ? II&4 LEGAL RESPONSIBILITIES LR Sho,s co--it-ent to the ,elfare of the fa-ily ? &4 ETHICO-MORAL RESPONSIBIITIES EMR% Sho,s a,areness of o,n feelings and reactions and their effect on fa-ily*client ? &I4 PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD% Accepts suggestion and constructi)e criticis-s. Manifests self direction Reports for duty*conference*consultation on ti-e. Sub-its re=uire-ents on ti-e. Sho,s initiati)e in acti)ities. ? ? ? &II4 ./ALIT0 IMPRO&EMENT .I% E)aluates plan of care ,ith the fa-ily !tilizes teacher0s super)ision effecti)ely. "iscusses difficulties encountered. See+s closer super)ision ,hen needed. Sho,s acti)e participation in group conferences*,ard classes :; :; :; &III4 RESEARCH R% "isplays critical thin+ing in the analysis of the health proble-s of the client*fa-ily. :; 64 RECORDS MANAGEMENT RM% . "ocu-ents care gi)en and client progress accurately :; 6I4 COLLABORATION AND TEAM$OR7 CT$% Ma+es referral to appropriate health care facilities. %-ple-ents the plan of care 8ointly ,ith the fa-ily Coordinates ,ith other -e-bers of the health tea- :; :; :; TOTAL MNP$ /D> M'P$ 479 /.>> 46D : 479 /.47 45F : 46C /.7> 45> : 45D /.C7 44/ : 44F 4.>> 4/4 : 44> 4.47 4>6 : 4// 4.7> /F9 : 4>5 4.C7 /DD : /F7 5.>> /D> : /DC Co--ents1 ######################################################## Signature of Student1###################### Signature of eacher1 ##################### "ate of E)aluation1 ####################### Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental
NAME OF S!"EN ############################## C$%N%CA$ AREA##################### %NC$!S%&E "AE OF E'PER%ENCE ################## (RA"E ############################ PERFORMANCE E&AL/ATION CHEC7LIST HOSPITAL E6PERIENCE ALL LE&ELS% Me#i'"l Surgi'"l Nursing Dire'(ion: Encircle the score if the beha)ior*s+ill ,as de-onstrated. %ndicate re-ar+s, as needed. BEHA&IOR+S7ILL SCORE REMAR7S I4 SAFE AND ./ALIT0 N/RSING CARE S.C% Assess health status. Perfor-s physical e3a-ination Correctly ;ith confidence "ifferentiates bet,een nor-al and abnor-al findings "etects abnor-alities in )ital signs "eter-ines the significance of laboratory and diagnostic findings to the current proble-s. Pic+s out critical and essential data in nursing history rele)ant to current situation. %dentifies nursing diagnosis in a syste-atic -anner Nursing diagnosis reflect hu-an response Nursing diagnosis reflect conditions pri-arily resol)ed by nursing inter)ention or therapy. Nursing diagnosis reflect etiology as the focus of treat-ent Correlates bet,een PE findings, nursing history, diagnostic*lab e3a- results. All e3isting nursing diagnosis are identified. Nursing diagnosis specifies the defining characteristics. Prioritizes nursing diagnosis For-ulates care plan for priority nursing proble-. "eter-ines the outco-e criteria Selects appropriate nursing actions Anticipates needs for future care )is a )is potential proble-. %-ple-ents care plan ,ith the client "e)elops the self : -anage-ent capability of the client Ensures safety, co-fort, pri)acy in rendering care Pro)ides necessary curati)e -easures e.g. air,ay -aintenance and o3ygenation, correct drug ad-inistration, corrects fluid and electrolyte i-balance and ad-inisters blood co-ponent, pro)ides peri : operati)e care. %-ple-ents the plan of care 8ointly ,ith the client. Perfor-s nursing procedures*acti)ities ;ith ease and confidence Correctly Syste-ically Pro)ides after care Re)ises care plan as needed ? > > :; :; :; :; :; :; :; :; :; > :; :; ? > > > > > > > > > > > II4 MANAGEMENT OF RESO/RCES AND EN&IRONMENT MRE% !tilizes a)ailable physical M professional resources !tilizes biobeha)ioral strategies ?e.g. -ind<body<spirit paradig- M reflecti)e of holis-A ? > III4 HEALTH ED/CATION HE% %n)ol)es the client in the details of the plan, as appropriate Pro)ides health teachings about restorati)e*rehabilitati)e -easures e.g. dietary regi-en, prescribed e3ercises, lifestyle -odification > > > I&4 LEGAL RESPONSIBILITIES LR% Sho,s co--it-ent to the ,elfare of the client &4 ETHICO MORAL RESPONSIBILITIES EMR% "e-onstrates core )alue. Sho,s honesty in data gathering, proble- identification, i-ple-enting inter)entions, reporting, recording and e)aluating outco-es. Manifests consistency in beliefs and actions. Sho,s sensiti)ity to social proble-s affecting the health status of the clientele being ser)ed. Considers the ethnic orientation of the client*fa-ily "isplays critical thin+ing in the analysis of the health proble-s of the client*fa-ily. Practices bioethical principles in care reats client ,ith respect Maintains fidelity Safeguards the right to pri)acy e.g. confidentiality and fa-ily Sho,s co-passion for the client and fa-ily "e-onstrates gender sensiti)ity in care Considers a holistic perspecti)e of the client "e-onstrates situational fle3ibility and adaptability Models good health habit ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? &%.PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD "e-onstrates attributes of a future professional Sho,s a,areness of o,n feelings and reactions and their effect on fa-ily*client. Accepts suggestion and constructi)e criticis-s Manifests self direction Reports for duty*conference*consultation on ti-e Sub-its re=uire-ents on ti-e Sho,s initiati)e in acti)ities !tilizes teacher0s super)ision effecti)ely "iscusses difficulties encountered See+s closer super)ision ,hen needed Sho,s acti)e participation in group conferences*,ard classes. ? ? ? ? ? ? ? ? ? ? :; &II4 ./ALIT0 IMPRO&EMENT .I% As appropriate, e)aluates plan of care, ,ith client using the outco-e criteria. Accepts suggestion and constructi)e criticis-s :; ? &III4 RESEARCH R% !tilizes research studies in i-ple-enting care :; I64 RECORD MANAGEMENT RM% Perfor-s accurate docu-entation and recording "ata is accurate "ata is co-plete Sho,s honesty in docu-entation On ti-e :; :; > > A 64 COMM/NICATION Establishes rapport ,ith the client Addresses client ,ith preferred na-e ? ? 6I4 COLLABORATION AND TEAM$OR7 CTM% Coordinates ,ith the other -e-ber of the health tea- ? TOTAL SCORE B9@ GRADE E./I&ALENT SCORING E./I&ALENT: /.> 59> : 59D /.47 575 : 57F /.7> 569 : 574 /.C7 55F : 567 4.> 554 : 55D 4.47 547 : 55/ 4.7> 5/D : 546 4.C7 4// : 5/C 5.> 5/> Co--ents1 ######################################################## Signature of Student1 ###################### Signature of Clinical %nstructor1 ###################### "ate of E)aluation1 ######################## Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental HEALTH ASSESSMENT PROCESS RECOR(IN+ ,Pro#u0t E=lution- N!e3 BBBBBBBBBBBBBBBBBBBBBBBBBB +roup3 BBBBBBBBBBBB Are3 BBBBBBBBBBBBBB (te In0lusi=e3 BBBBBBBBBBBBBBBBBBB Clini0l Instru0tor3 BBBBBBBBBBBBBBBBBBBBBB ITEMS SCOR E REMARK S I) he obIecti.es of the interaction are spe0iD0 and !esur%le) ,6- II) "escription of the conte1t under /hich the interaction occurred is %rief but 0on0ise'00urte) ,6- III) Record of actual interaction re0ects the follo/ing, Establishes rapport and trust /ith the client) ,.- %denti-es e>ects of the techni?ues used /hether positi.e or negati.e) ,6- er2inates the interaction 0orre0tl> and ppropritel>) ,.- IV) Analysis of the interaction re0ects the follo/ing, Recognizes appropriateness of therapeutic co22unication techni?ues used) ,6- %denti-es e>ects of the techni?ues used /hether positi.e or negati.e) ,1- "ocu2entation of analysis, /here pertinent) ,6- (e=elop!ent of insig"t ,1- V) E.aluation of the interaction is based on the obIecti.es) ,6- TOTAL ,6 C- Perfect Score, 6E Passing Score, *6 3CEJ4 Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental HEALTH ASSESSMENT PRO(UCT EVALUATION OF PH&SICAL E:AMINATION N!e3 BBBBBBBBBBBBBBBBBBBBBBBBBB +roup3 BBBBBBBBBBBB Are3 BBBBBBBBBBBBBB (te In0lusi=e3 BBBBBBBBBBBBBBBBBBB Clini0l Instru0tor3 BBBBBBBBBBBBBBBBBBBBBB For each section of the physical e1a2ination, e.aluate /hether -ndings /ere co2plete, accurate, and recorded correctly) ITEMS CRITERIA A00ur te Co!ple te Re0or# e# Corre0tl > "e2ographic "ata (eneral Appearance &ital Signs S=in Kead Eyes Ears Nose Pharyn1 Mouth Nec= Chest and $ungs Keart Abdo2en (enitoLurinary Syste2 Mac= and E1tre2ities OA$, Perfect Score, 9G Passing Score, 6G)G 3CEJ4 Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental Nursing Foun#tion Course ,NCM .CC'HEALTH ASSESSMENT- PRO"!C E&A$!A%ON OF N!RS%N( K%SOR@ N!e3 BBBBBBBBBBBBBBBBBBBBBBBBBB +roup3 BBBBBBBBBBBB Are3 BBBBBBBBBBBBBB (te In0lusi=e3 BBBBBBBBBBBBBBBBBBB Clini0l Instru0tor3 BBBBBBBBBBBBBBBBBBBBBB +or each section of the nursing history from belo#$ e(aluate the accuracy and completeness of findings and #hether findings are stated correctly. ITEMS CRITERIA A00ur te Co!pl ete Stte# Corre0tl > A) Contains 0ler8 00urte8 and 0o!pre"ensi=e %nfor2ation on the follo/ing, "e2ographic "ata Chief Co2plaint Kistory of present illness Past illness history Fa2ily illness history Kealth perception7Kealth Manage2ent Patterns Nutritional7Metabolic Pattern Eli2ination Pattern Acti.ity7E1ercise Pattern Sleep7Rest Pattern Cogniti.e7Perceptual Pattern SelfLPerception7SelfLConcept Pattern RoleLRelationship Pattern Se1uality7Reproducti.e Pattern Coping7Stress olerance Pattern &alue7Melief Pattern M) Recorded data 0orre0tl> in appropriate for2s) Perfect Score, 9G Passing Score, 6G)G 3CEJ Republic of the Philippines PNO-NONESCOST College of Nursing Cadiz City, Negros Occidental NAME OF S!"EN ############################# C$%N%CA$ AREA ####################### %NC$!S%&E "AE OF R$E E'PER%ENCE ############### (RA"E ############################### CLINICAL PERFORMANCE RATING SCALE: HOSPITAL BASED ER! OPD "n# $ARD% LE&EL I&% Dire'(ion: Place the actual score if the beha)ior*s+ill described ,as de-onstrated. %f it ,as not de-onstrated include re-ar+s in the space pro)ided. Be)"*ior+S,ill S'ore Re-"r,s D A %. SAFE AND ./ALIT0 N/RSING CARE S.C% A11lies ()e nursing 1ro'ess in ()e '"re of 1"(ien(s 2i() 1ro3le-s of nu(ri(ion "n# -e("3olis-! 1er'e1(ion "n# 'oor#in"(ion! "l(er"(ions in i--une res1onse "n# infe'(ion! 'ellul"r "3err"(ion "n# re)"3ili("(ion4 /./ Assess the client0s health status based on1 Nursing 2istory Measures )ital signs accurately Physical Assess-ent "iagnostic*$aboratory e3a-s / .4 Analyzes client0s data utilizing the appropriate theoretical fra-e,or+. /.5 "efines the nursing diagnosis /.6 Prioritizes the nursing diagnosis /.7 For-ulates plan of care. %dentifies (oals*Ob8ecti)es Specifies appropriate nursing inter)entions "efines e)aluation criteria /.9 %-ple-ents appropriate inter)entions 2ealth pro-oting inter)entions %llness pre)enting inter)entions Curati)e*restorati)e inter)entions Supporti)e biobeha)ioral inter)entions Rehabilitati)e inter)entions %nter)entions specific to the nursing diagnosis identified Obser)es principles for safety, pri)acy and co-fort ,hen pro)iding care. (i)es full attention to patient*client ,hen gi)ing care. Pro)ides nursing care based on the indi)idual0s needs 5 4 5 4 4 5 4 5 5 4 4 4 5 5 4 4 4 6 5 4 5 4 II4MANAGEMENT OF RESO/RCES! EN&IRONMENT AND E./IPMENT MRE% Adapts en)iron-ent to -a+e it conduci)e for healing*pleasing of the patient. 4 III4 HEALTH ED/CATION HE% Pro)ides appropriate health education and health teachings 4 I&4 LEGAL RESPONSIBILITIES LR% Maintains confidentiality of patient*client and staff. Safeguards the indi)idual0s rights to pri)acy Pre)ents and*or -anages proble-s related ,ith specific phase of the nurse : client relationship. 4 / / &4 PERSONAL AND PROFESSIONAL DE&ELOPMENT PPD% De-ons(r"(es 1osi(i*e "((i(u#es 35: 7./ Obser)es bedside -anners and courtesies. 7.4 Respects client0s spirituality and cultural needs. 7.5 "e-onstrates honesty in reporting*recording data. 7.6 "e-onstrates co-passion, genuine concern for patient0s ,elfare, and caring not only for patient but also to the fa-ily*support syste-. 7.7 Presents self in a -anner that pro-otes the i-age of nursing. ;ell groo-ed Pleasant disposition / / 4
4 / / &I4 ./ALIT0 IMPRO&EMENT .I% E)aluates client0s response*outco-es of care based on criteria !ses feedbac+*clinical super)ision to i-pro)e nursing care. Sho,s ho, feelings*reactions can be -anaged to -aintain standards of care. !ses an updated re)ie, of literature in1 < "e)eloping the nursing care plan. < ;ard conference*Case presentation 5 4 4 4 &II4 ETHICO-MORAL RESPONSIBILITIES EMR% Dis1l"5s self #ire'(ion "n# self #is'i1line Reports for duty on ti-e. Sub-its re=uire-ents on ti-e. Finishes ,or+ on ti-e. Sho,s initiati)e in acti)ities. "e-onstrates effecti)e ti-e -anage-ent "e-onstrates honesty in reporting*recording data. / / / 4 4 4 &III4 RESEARCH Proposes possible solutions*options to proble-s*issues identified utilizing research studies 4 I64 RECORD MANAGEMENT RM% "e-onstrates accuracy and honesty in recording and reporting4 4 64 COMM/NICATION "e-onstrates therapeutic co--unication s+ills. %ntroduces self and addresses patients*clients, other indi)iduals as they prefer to be addressed. reats others ,ith respect regardless of bac+ground. 4 / / 6I4 COLLABORATION AND TEAM$OR7 S)o2s le"#ers)i1 in '"ring for ()e 1"(ien(s 35: Collaborates ,ith -e-bers of the health tea- in)ol)ed in client care %nitiates acti)ities or inter)entions to pro-ote*-aintain health of pre)ent illness. Supports the rights of other pro)iders to suggest alternati)es to the plan of care. 4 4 / TOTAL SCORE />> GRADE E./I&ALENT Co--ents1 ######################################################## Signature of Student1 ###################### Signature of eacher1 ##################### "ate of E)aluation1 ####################### CLINICAL PERFORMANCE E&AL/ATION GRADING S0STEM: 89 :;; < :4;; =; => < ?4>; 8? 8> < :4?> 9> 98 < ?4=> @@ 8: < :4>; 9; 9A < B @A @= < :4=> >> >8 < A @; @B < ?4;; BELO$ >> < > =9 =8 < ?4?>