DMC COLLEGE FOUNDATIONSta. Filomena, Dipolog City

Midwifery DepartmentMID 102- RLE

CLINICAL TEACHING PLAN ON CARE OF MOTHERS DURING LABOR AND DELIVERY (Intrapartal Care)

Description : This clinical teaching plan will serve as a guide for the faculty/Clinical Instructor and students in developing the core competencies required of delivery room midwife during actual labor and delivery.

Area of Exposure : Delivery Room/ Lying InDuration : 48 hours

Entry Competencies : Knowledge in MID 103 especially in the care of mother during labor and delivery, Human Anatomy and Physiology, Aseptic Technique and Principles, DR Instrument, Supplies and Equipment, Drugs and Solutions, Anesthesia, Principles of Bio-Ethics, Skills in doing the Nursing process especially assessment skills ( Leopold’s Manuever, FHT determination etc. learned during prenatal care, Surgical aseptic technique, hand scrub, gowning and gloving, perineal care, positioning and draping, enema administration, catheterization, skills in doing Ritgen’s manuever and Crede’s manuever, decision- making skills/ critical thinking skills, proper attitude of prudence, patience, accuracy and gentleness in handling client’s in stress).DR Orientation Activities for Clinical Instructor : Must have been completed prior to students exposure and done in coordination with the affiliating hospital training officer or DR head nurse for a week depending on hospital policies.DR Orientation activities for students (done before the actual exposure or on the 1st day of clinical experience)

Orientation on the following:1. DR personnel/organizational chart2. DR set-up; supplies, instruments and equipments3. DR protocols, policies and guidelines4. DR records and forms ( for documentation, requisitions etc)5. Practice of skills- ( e.g. Hand scrub, gowning,. Gloving

Setting up of DR table, mayo table6. Grading system and requirements- attendance, Drug Study, performance Evaluation Checklist on Intrapartal Care7. Observation of an actual delivery ( during observation, CI discusses procedures and processes)

Daily Protocol after orientation: Pre-conference Actual clinical experience Quizzes Post Conference

Last Day of Experience: Final evaluation of Student Performance through Comprehensive exam or skills inventory.

Intermediate Competencies Clinical Activities

Method of Evaluation

Faculty Students

I. Safe and Quality Nursing CareA. Utilizes the nursing process in the care of DR clients

1. Performs comprehensive and systematic nursing assessment

2. Implements planned nursing care to achieve identified outcomes

B. Promotes safety and comfort of patients inside the DR

C. Provides health care therapeutically and safely.

1. Evaluates progress toward expected outcomes

Assigns students to a particular patient in labor room

Supervises students in assessment of clients.

Assists the student in validating completeness and veracity of assessment data.

Instructs students to monitor the progress of labor.

Supervises students as they perform nursing intervention safely

Gives appropriate feedback as necessary.

Discusses with the students results of evaluation and reviews data before final recording

Receives a client for careObtains obstetrical history including parity, gravida score, LMP, EDC, AOG, BOW onset of true labor.Obtains data from the Client’s chartChecks vital signsConducts Physical ExaminationChecks Fetal Heart Rate and Fundic heightMonitors progress of labor/ uterine contractions as to:

Frequency Duration Intensity Interval

Observes for the timely rupture of BOW

Performs appropriate nursing interventions based on identified problem/ diagnosis

Transports clients safely while providing privacy

Places mother in lithotomy position Performs perineal care using sterile technique

correctly Performs proper hand scrub Wears gown and gloves according to hospital

policy Performs Ritgen’s maneuver safely Coaches mother on breathing and pushing

techniques Delivers baby and placenta carefully Checks and manages cord recoil correctly Clamps and cuts the cord correctly

Evaluation of Assessment Record

Performance Evaluation Checklist

Quizzes

II. Management of Resources,

Environment and EquipmentOrganize work load to facilitate patient care.

A.Utilizes adequate and appropriate resources to support patient care

B. Ensures functioning of DR resources

C. Maintains a safe environment at the DR

Reviews with the students the concept of management of resources and environment pertaining to DR guidelinesFamiliarizes students with the different instruments, supplies and equipment in the DR.

Assists students in performing sterilization procedure and preparation of supplies needed.Supervises students in proper waste disposal/ discusses rationale of procedures

Identifies signs of placental separation Checks the characteristics/ completeness of

the placentaAssesses the amount of blood loss (Normal less than500 cc)

Employs interventions to achieve and maintain a well contracted uterus to prevent/ control haemorrhage

Uterine massage Correct administration of

oxytocin Cold Compress

Assists in episiorrhapy as neededChecks size, consistency and location of uterusPerforms perineal care and applies pad correctlyProvides emotional support to the mother throughout labor and deliveryObserves universal precautions in handling body fluids

Evaluates patient’s condition and record pertinent data Accordingly.

Prepares patient for transfer to recovery room/ wardPrepares room, instruments and equipment needed

Sterile drape Sterile instruments and equipment

(forceps, scissors, bulb syringe, gauze, suture, needle holder, catheter)

Kelly pad Disinfectant

Performs sterilization procedureMaintains adequacy of supplies as the delivery progressesObserves precautionary measures related to use of electrical equipmentEnsures a quiet environmentUses supplies diligently

III. Health Education Implements appropriate health education activities to client based on

the result of the assessment

II. Legal Responsibility Adheres practices in accordance with the midwifery law and other relevant legislation including contracts, informed consent

A. Adheres to organizational policies and procedures

B. Documents care rendered to patients

Reviews teaching plan of students

Supervises students during coaching in actual labor noting when to bear down and when to relax

Supervises students when doing health education on breastfeeding, bathing, diapering and administration of ordered medications

Assists the students in securing informed consent in all procedures

Validates with the students accuracy of the data gathered.Checks proper identification of mother and the newborn

Checks correctness and completeness of documents.

Performs after care of materials and equipment usedEnsures proper disposal of hospital waste including blood and other fluids.

Teaches client on basic preparation during labor and deliveryCoaches client on breathing/ bearing down technique

Gives instructions to patient and significant others as to bathing, proper hygiene and ROM exercisesDemonstrates proper “latch – on” breast feeding techniqueGives instructions to parents regarding infant care before discharge/Provides discharge instructions as to feeding, bathing, administration of ordered medications, appointment dates for post natal and well baby check upResponds to questions of clients and relatives regarding expectations

Evaluation of Teaching Plan