Maternal-Infant Nursing Core Competencies Individual Assessment

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1 Individual Name: Orientation Start Date: Completion Date: Instructions: Pre- - the nurse will rate each knowledge, skill, or attitude (KSA) from 1 (novice) to 5 (expert) in each box. Following orientation or training, the nurse and preceptor will collaboratively provide a post-assessment. Competency Foundational/Generic Nursing Competencies (consistent for all RNs) Traumatic Brain Injury and Operational Stress Awareness Identifies signs and symptoms of Traumatic Brain Injury. Demonstrates awareness of early cognitive and behavioral changes Identifies signs and symptoms of Post Traumatic Stress Disorder. Demonstrates awareness of early cognitive and behavioral changes Critically reviews patient or family past and planned deployment cycle and any change in alcohol use/misuse Apply operational/occupational stress control concepts to assess patients, peers, and units. Applies Stress First Aid to patients, peers, and units Physiologic and Psychosocial Adaptation to Pregnancy Describe health-related factors that can influence conception and pregnancy Describe the physiologic changes that occur during pregnancy, including reproductive hormonal changes, cardiovascular, and renal changes Describe normal weight gain in pregnancy, including expected metabolic and gastrointestinal changes CRITICAL THINKING: Recognizes key symptomology of combat operational stress, PTSD, and traumatic brain injury. Identifies need for referral/evaluation of stress reduction, psychoeducation, and behavioral health interventions for the prevention of and reduction of operational stress disorders for the patient/family system CRITICAL THINKING: Develops an individualized nursing plan of care that is appropriate for pregnancy gestation. (1) Module I (7) Chapters 5, 6 Self Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

2 Identify changes in laboratory values that occur during pregnancy as a result of normal physiologic adaptation Identify psychosocial and developmental adaptations to pregnancy, including issues related to mood, anxiety, body image, pregnancy attachment, sexuality and relationships, and expected changes in sleep patterns, appetite, and energy levels Identify lifestyle choices that can adversely affect pregnancy Define common complications of pregnancy: gestational hypertension, gestational diabetes, polyhydramnios, oligohydramnios, intrauterine growth restriction, etc. Describe the process for prenatal care, including the nine visit pathway, common laboratory assessments, and prenatal risk assessment (aneuploidy screening, amniocentesis) Antepartum Describe the key elements of triage assessment and evaluation. List common presenting conditions and categorize appropriately as emergent, urgent, or routine Assist with the collection of vaginal cultures/testing according to unit guidelines and identify rationale for each: nitrazine, ferning, amnisure, fetal fibronectin, group beta strep, chlamydia, gonorrhea, KOH, wet prep Describe the process and nursing responsibilities for assessment of ruptured membranes Demonstrate proper technique for cervical examination and identify situations in which cervical exam should only be performed by privileged provider Assist with amniocentesis and external cephalic version according to facility guidelines Individual Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment CRITICAL THINKING: Develops an individualized nursing plan of care that is appropriate for pregnancy gestation. (4) Module 3 (7) Chapter 7

3 Describe procedure and evaluation criteria for fetal nonstress test, contraction stress test, amniotic fluid index, biophysical profile The Process of Labor and Birth Identify maternal coping behaviors related to labor and birth Describe required assessments and basic interventions for an intrapartum admission Describe the four stages of labor. Differentiate between expectations for nulliparous and multiparous women Describe various position for labor and birth that may improve maternal and fetal outcomes Discuss principles of electronic fetal heart rate monitoring and its use in labor and birth Identify patients who may be candidates for intermittent monitoring and verbalize procedure according to unit guidelines Demonstrate assessment of fetal response to labor and evidence of fetal well-being or compromise through evaluation of fetal heart rate baseline, variability, and periodic changes Discuss indications for and use/risks of internal monitors (fetal scalp electrode and intrauterine pressure catheter) Identify and demonstrate prioritized sequence for intrauterine resuscitation of the compromised fetus Discuss methods of pain relief utilized during labor, including relaxation techniques, IV pain medications, and regional analgesia Demonstrate appropriate nursing management of the patient receiving regional analgesia Individual CRITICAL THINKING: Develops an individualized nursing plan of care that aligns with healthcare provider orders and stage of patient labor process (1) Module II (4) Modules 4-7 (5) (7) Chapters 9-11 Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

4 Demonstrate ability to evaluate labor progress and differentiate normal and dysfunctional labor, including assessment of cervical change and fetal descent Determine frequency, duration, and quality of uterine contractions and their expected relationship to labor progress. Differentiate between external and internal monitoring List the indications for labor induction. Differentiate between induction and augmentation of labor Identify common agents (cytotec, cervidil, foley bulb, intravenous oxytocin, AROM) and describe procedure for safe induction of labor Describe the nurse s role in the use of cytotec, foley bulb, and AROM for induction/augmentation of labor Describe the procedure for safe, effective administration of intravenous oxytocin for induction or augmentation of labor Explain the evidence-based nursing management of second stage labor Identify the steps to prepare the room for delivery and newborn resuscitation Demonstrate delivery of an infant in the absence of the primary privileged provider Explain the nursing considerations for operative vaginal delivery Identify indications for operative delivery of the laboring patient Demonstrate prioritized nursing interventions to prepare for and initiate emergent cesarean section Demonstrate preparation of a patient for scheduled or routine cesarean section Individual Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

5 Complications of Pregnancy: PART I and PART II Outline the standard intrapartum treatment for a patient with known positive group beta strep (GBS) Identify common reproductive tract infections and the appropriate management of each Describe nursing care to prevent chorioamnionitis. Identify signs and symptoms and appropriate management of the patient with chorioamnionitis Describe theories of etiology, pathophysiology and management of hypertensive disorders in pregnancy Demonstrate appropriate nursing management of a patient with pre-eclampsia. List prioritized interventions in case of eclamptic seizure Describe risk factors, theories of etiology, and management of preterm labor Recognize the signs and symptoms of and treatment modalities for preterm labor Describe safe and effective administration of magnesium sulfate therapy. Define signs and symptoms of magnesium toxicity and subsequent interventions Describe pathophysiology and management of bleeding disorders in pregnancy (positive antibody screen, coagulation disorders, Rh sensitization) Identify the signs and symptoms of placenta previa and placental abruption, and list appropriate actions in case of bleeding emergency Identify risk factors for postpartum hemorrhage Outline the priorities and interventions in a postpartum hemorrhage Differentiate the types of diabetes, risk factors, and management in pregnancy Individual CRITICAL THINKING: Develops an individualized nursing plan of care that is appropriate for patient pregnancy complications to facilitate a positive outcome (1) Module III (4) Modules 8-13 (7) Chapter 8 (1) Module III (4) Modules 8-13 (7) Chapter 8 Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

6 Demonstrate the nursing management of the patient receiving intravenous insulin during labor and birth State the risk factors for shoulder dystocia, and describe the collaborative measures to relieve shoulder dystocia Identify signs of and interventions for a possible prolapsed umbilical cord Describe the prevalence and physiology of multiple gestations and nursing care of women with twins and higher order multiples Demonstrate nursing management of labor and birth for the patient with multiple gestation Describe multidisciplinary management of pregnant women with low, moderate, or high-risk cardiac disease and its impact on labor and birth Discuss the incidence, risk factors, signs and symptoms for venous thromboembolism and pulmonary embolus during pregnancy. Outline steps for pertinent DVT prophylaxis Outline the management of a patient diagnosed with pulmonary embolus Describe the prevalence, epidemiology and comorbidity associated with obesity in pregnancy Describe the appropriate assessment and care of the obese woman in labor and delivery Postpartum and Nursing Care Describe the normal physiologic changes occurring during the postpartum period Describe the postpartum plan of care for women with cesarean section, pre-eclampsia, s/p postpartum hemorrhage, and third/fourth degree lacerations Differentiate normal from abnormal emotional changes during postpartum Individual CRITICAL THINKING: Develops an individualized nursing plan of care that meets physiologic/psychosocial needs of mother and newborn (1) Module IV (4) Module 15 (7) Chapter 12 Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

7 Differentiate normal from abnormal physiologic changes during the postpartum period Identify signs and symptoms of postpartum complications (hypertensive disorders, hemorrhage, infection, mood disorders) Describe the physiology of normal lactation Outline techniques to assist and support the initiation of breastfeeding in the immediate postpartum period Demonstrate nursing interventions which promote family-infant bonding Newborn and Nursing Care Describe physiologic changes that occur during the transition from fetal to neonatal life Describe the process of immediate newborn assessment and stabilization Demonstrate steps for routine and complicated neonatal resuscitation Perform initial newborn assessment, gestational age assessment, and bath Identify interventions to prevent and treat hypothermia Identify risk factors for and interventions to prevent and treat mild hypoglycemia Identify risk factors for and interventions to prevent hyperbilirubinemia Describe normal newborn behavioral states Describe routine care and assessment of the low risk newborn Neonatal Complications Describe characteristics of preterm, post-term, small-for gestational age (SGA), and large-forgestational age (LGA) infants Individual CRITICAL THINKING: Develops an individualized nursing plan of care that fosters and facilitates parents knowledge and skills to provide newborn care at home (1) Module V, VI (4) Module 15 (7) Chapter CRITICAL THINKING: Develops an individualized nursing plan of care that will enable the nurse to stabilize the distressed newborn while awaiting for transport to higher level of care (1) Module VI (7) Chapter 17 Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

8 Review maternal risk factors predisposing to premature and post-mature birth, SGA & LGA infants Identify signs & symptoms of respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), and meconium aspiration syndrome (MAS) Describe pathophysiology and risk factors for RDS, TTN & MAS Identify risk factors for and signs and symptoms of neonatal sepsis Recognize symptoms of drug withdrawl in the neonate related to maternal drug abuse Identify risk factors and complications associated with the infant of a diabetic mother Demonstrate nursing care of the low-risk newborn with hyperbilirubinemia Perinatal Medication Safety Discuss and demonstrate administration of highrisk medications (pitocin, magnesium sulfate, methergine, hemabate, cytotec) Describe actions needed to ensure safe medication administration in the perinatal nursing environment Perinatal Loss Define perinatal loss, including differentiation of types and frequency Describe unique aspects of perinatal loss including the process of grief and mourning Assess meaning and attachment to the pregnancy, and provide interventions appropriate to family response Demonstrate nursing interventions for the care of the grieving family Individual CRITICAL THINKING: Develops an individualized nursing plan of care by utilizing five rights, medication interactions and potential impact on lactation (1) Module VII CRITICAL THINKING: Develops an individualized nursing plan of care that facilitates and supports family grieving processes (1) Module IX (7) Chapter 13 (1) Module IX (7) Chapter 13 Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

9 Describe anticipatory guidance for self care following discharge Recognize the potential effects of perinatal loss on subsequent children and parenting Documentation, Communication and Risk Management Discuss principles of documentation based on AWHONN and ANA guidelines Describe principles of professional communication (SBAR, TeamSTEPPS) Identify perinatal risk management strategies Individual CRITICAL THINKING: Ensure compliance with local MTF SOP and Policy (1) Module VIII (7) Chapters 2-3 Required Courses/Training Basic and intermediate Electronic Fetal (2) Monitoring Neonatal Resuscitation Program (3) S.T.A.B.L.E. (9) Advanced Life Support Obstetrics (ALSO) (10) P.O.E.P (1) Recommended Courses/Training Telephone Triage for the obstetric nurse (8) Perinatal Bereavement (6) Breastfeeding for the Health Care Provider Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

10 Individual Result Recommended Result Total Post- Points (96 items max = 480 points max) Overall Recommended Result Novice Advanced beginner Competent Proficient Expert Appendix A: REFERENCES Association of Women s Health, Obstetric and Neonatal Nurses Perinatal Orientation and Education Program 3 rd Ed AWHONN Intermediate Fetal Monitoring Course American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program 4. Martin, E.J. (2009). Intrapartum Management Modules (4 rd Ed). Lippincott: Philadelphia. 5. Murray, M. & Huelsmann, G. (2008). Labor and Delivery Nursing: Guide to Evidence-Based Practice. Springer: New York. 6. RTS Bereavement Services (2008). RTS Bereavement Training Manual. Gunderson-Lutheran: LaCrosse, WI. 7. Simpson, K.R., & Creehan, P.A. (2013). Perinatal Nursing (4th Ed). Lippincott: Philadelphia. 8. Woodke, D. (2010). Telephone Triage Decision Support Tools for Nurses. Ambulatory Innovations: Hot Springs, AR. 9. The S.T.A.B.L.E. Program. Learner/Provider Program with Learner Manual: 6 th Edition American Academy of Family Physician s Advanced Life Support in Obstetrics-Provider Self- Evaluation Method Pre- Page Total: 4 = Proficient (Specialty cert. Prioritizes given evolving circumstances. Uses rules for guidance) V = Verbal Note: Pre- is the nurses self-assessment in the knowledge, skill, or attitude; post-assessment

11 Summary Comprehensive assessment, planning, implementation and evaluation of care to include: Develops an individualized nursing plan of care that is appropriate for pregnancy gestation Develops an individualized nursing plan of care that aligns with healthcare provider orders and stage of patient labor process Develops an individualized nursing plan of care that is appropriate for patient pregnancy complications to facilitate a positive outcome Develops an individualized nursing plan of care that meets physiologic/psychosocial needs of mother and newborn Develops an individualized nursing plan of care that fosters and facilitates parents knowledge and skills to provide newborn care at home Develops an individualized nursing plan of care that will enable the nurse to stabilize the distressed newborn while awaiting for transport to higher level of care Develops an individualized nursing plan of care by utilizing five rights, medication interactions, and potential impact on lactation Develops an individualized nursing plan of care that facilitates and supports family grieving processes Ensure compliance with local MTF SOP and Policy regarding documentation, communication, and risk management Treatment Facility: Nurse Name: Preceptor s Printed Name: Date Assessed: Current Competency level: Signature: I understand that of all the competencies listed, I will be allowed to perform only those for my skill level/scope of practice and only after I have successfully demonstrated competency. Nurse s Signature: CNS/Division Officer s Signature: Date: Date:

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