Competency Validation Record
Competency: Breastfeeding
Name: ______________________________
Validator: ____________________________
Date: ______
Written Quiz:
Number of Correct Answers on 56 items: ______
Circle the numbers of the items that were not correctly answered. Example: For item 53-55, "List at least 3 alternative feeding methods for expressed milk." If the person wrote two correct answers, circle 54, indicating the missed third response.
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
| 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 |
| 21 | 21 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 20 |
| 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39 | 40 |
| 41 | 42 | 43 | 44 | 45 | 46 | 47 | 48 | 49 | 50 |
| 51 | 52 | 53 | 54 | 55 | 56 |
For the following items, place a check by each skill demonstrated correctly:
I. MCH HV nurse demonstrates knowledge of and ability to determine, with client, her goals and plan of care.
____ 57. Elicits mother’s feelings and concerns about breastfeeding (I.4)
____ 58. Determines and supports maternal breastfeeding goals (I.5)
____ 59. Involves mother in identifying breastfeeding support system (I.6)
____ 60. Involves mother in developing and implementing a plan for priority
concerns (I.7)
____ 61. Recognizes cues of maternal fatigue and avoids overwhelming mother
with information (1.8)
____ 62. Demonstrates 1 of these three skills:
____ 63. Demonstrates a different 1 of these 3 skills:
- Individualizes care based on cultural influences (I.9)
- Prioritized breastfeeding concerns for each mother baby couple (I.10)
- Recognizes own knowledge limitations and consults other sources as needed (I.11)
II. MCH HV nurse demonstrates knowledge and ability to assess and educate mother regarding self care related to breastfeeding.
____ 64. Involves mother in planning to promote relaxation and enjoyment of breastfeeding (II.6)
III. MCH HV nurse demonstrates knowledge of and ability to assess newborn feeding.
____ 65. Demonstrates cradle hold, football hold, side lying positions for
breastfeeding (111.10)
____ 66. Demonstrates 1 or more techniques for detaching newborn from breast
(III.11)
____ 67. Demonstrates 1 or 2 techniques for burping baby (III.12)
____ 68. Creates an environment of privacy for communication and/or physical
assessment (III.13)
____ 69. Obtains consent before touching patient (III.14)
____ 70. Considers the effects of medications mother is using on
breastfeeding and newborn health (III.15)
IV. MCH HV nurse demonstrates knowledge of and ability to teach regarding methods of expressing, storing, and feeding breast milk.
____ 71. Demonstrates correct use of breast pumps available in the area
(IV.3)
____ 72. Explores ways with client to continue breastfeeding while separated
from baby (IV. 4)
Total number of correct responses of 72: ______
A passing score is 75% (54 correct responses) and must include the items on the first page that are in bold (1, 2, 3, 4, 5, 6, 7, 8, 9, 26, 27, 28, 32, 33, 34, 35, 42, 43, 44, 45, 56)