INDIAN NURSING COUNCIL NURSE PRACTITIONER IN FAMILY HEALTH NPFH POSTGRADUATE RESIDENCY PROGRAM REGULATIONS 2024

The Gazette of India EXTRAORDINARY PART III—Section 4 PUBLISHED BY AUTHORITY NEW DELHI, FRIDAY, DECEMBER 27, 2024/PAUSHA 6, 1946 No. 1081] CG-DL-E-03012025-259878 INDIAN NURSING COUNCIL NOTIFICATION New Delhi, the 18th December, 2024 INDIAN NURSING COUNCIL {NURSE PRACTITIONER IN FAMILY HEALTH (NPFH) - POSTGRADUATE RESIDENCY PROGRAM} REGULATIONS, 2024 F.No. 11-1/2024-INC (VI):––In exercise of the powers conferred by sub-section (1) of Section 16 of Indian Nursing Council Act, 1947 (XLVIII of 1947), as amended from time to time, the Indian Nursing Council hereby makes the following regulations, namely:— 1. SHORT TITLE AND COMMENCEMENT i. These Regulations may be called the Indian Nursing Council {Nurse Practitioner in Family Health (NPFH) - Postgraduate Residency Program} Regulations, 2024. ii. These shall come into force on the date of notification of the same in the Official Gazette of India. 2. DEFINITIONS In these Regulations, unless the context otherwise requires, i. ‘the Act’ means the Indian Nursing Council Act, 1947 (XLVIII of 1947) as amended from time to time; ii. ‘the Council’ means the Indian Nursing Council constituted under the Act; iii. ‘SNRC’ means the State Nurse and Midwives Registration Council, by whichever name constituted, by the respective State Governments; iv. ‘RN & RM’ means a Registered Nurse and Registered Midwife (RN & RM) and denotes a nurse who has completed successfully, recognised Bachelor of Nursing (B.Sc. Nursing) or Diploma in General Nursing and Midwifery (GNM) course, as prescribed by the Council and is registered in a SNRC as Registered Nurse and Registered Midwife; v. ‘Nurses Registration & Tracking System (NRTS)’ means a system developed by the Council and software developed in association with National Informatics Centre (NIC), Government of India, and hosted by NIC for the purpose of maintenance and operation of the Indian Nurses Register. It has standardised forms for collection of the data of Registered Nurse and Registered Midwife (RN & RM)/Registered Auxiliary Nurse Midwife (RANM)/Registered Lady Health Visitor (RLHV) upon Aadhar based biometric authentication; vi. ‘NUID’ is the Nurses Unique Identification Number given to the registrants in the NRTS system; vii. ‘General Nursing and Midwifery (GNM)’ means Diploma in General Nursing and Midwifery qualification recognized by the Council under Section 10 of the Act and included in Part-I of the Schedule of the Act. NURSE PRACTITIONER IN FAMILY HEALTH (NPFH) - POSTGRADUATE RESIDENCY PROGRAM I. Introduction and Background In India, reshaping health systems in all dimensions of health has been recognized as an important need in the National Health Policy, 2017 (NHP, 2017). It emphasizes human resource development in the areas of education and training alongside regulation and legislation. The government recognizes significant expansion in specialty and super specialty services both in public and private health sectors. It is highly significant that the health care professionals require advanced educational preparation in building their capacity in providing specialized care. Developing training programs and curriculum in the area of care is recognized as the need of the hour. Nurse Practitioners will be able to meet this demand provided they are well trained and empowered to practice. With establishment of new cadres in the Centre and State level, master level prepared NPs particularly Nurse Practitioners in Family Health will be able to provide cost effective, competent, safe and quality driven primary health care to patients in various community settings. Nurse practitioners have been prepared and functioning in USA since 1960s, UK since 1980s, Australia since 1990s and Netherlands since 2010. Nurse Practitioners in Family Health (NPFH) can be prepared to function in primary and secondary care settings. Rigorous educational preparation will enable them to assess and participate in treating patients with acute and chronic illnesses both for prevention and promotion of health. A curricular structure/framework is proposed by the Council towards preparation of Nurse Practitioner in Family Health (NPFH) Program at Masters Level. The special feature of this program is that it is a clinical residency program emphasizing a strong clinical component with 15% of theoretical instruction and 85% of practicum. Competency based training is the major approach and NP education is based on competencies adapted from International Council of Nurses (ICN, 2020), and NONPF Competencies (2022). Every course is based on achievement of nurse practitioner competencies. Nurse Practitioner in Family Health (NPFH) – Residency Program is intended to prepare registered B.Sc. Nurses to provide advanced nursing care to patients who are acutely and chronically ill, using family centered approach. The nursing care is focused on stabilizing patients’ condition, minimizing complications and maximizing restoration of health. These Nurse Practitioners in Family Health are required to practice in primary or secondary health care settings. The program consists of various courses of study that are based on strong scientific foundations including evidenced based practice and the management of complex health systems. These are built upon the theoretical and practice competencies of B.Sc. trained nurses. On completion of the program and registration with respective SNRC, they are permitted to practice all competencies listed in the log book of the Council syllabus and also independently administer drugs and order diagnostic tests, procedures, medical equipment and therapies as per institutional protocols/standing orders. The Nurse Practitioners in Family Health, when exercising this authority, are accountable for demonstrating the competencies in a) Using scientific knowledge and theoretical foundations in family health related nursing practice. b) Patient selection/admission and discharge in various health care settings. c) Problem identification through appropriate assessment. d) Selection/administration of medication or devices or therapies. e) Patients’ education for use of therapeutics. f) Knowledge of interactions of drugs/therapeutics. g) Evaluation of outcomes. h) Recognition and management of complications and untoward reactions. i) Providing guidance, consultation, mentorship and educational experiences to students, nurses and other health professionals regarding family health care. j) Contribution towards evidence-based innovations in family health nursing practice. The Nurse Practitioner in Family Health is prepared and qualified to assume responsibility and accountability for the care of family under his/her care. The said postgraduate degree will be registered as an additional qualification by the SNRC. Philosophy The Council believes that there is a great need to establish a postgraduate program titled Nurse Practitioner in Family Health (NPFH) to meet the challenges and demands of primary and secondary health care services in India which is reflected in the National Health Policy, 2017 in order to provide quality care to acutely and chronically ill patients and families in various family health care settings. The Council believes that postgraduates from a residency program focused on strong clinical component and competency-based training must be able to demonstrate clinical competence based on sound theoretical and evidence- based knowledge. The teaching learning approach should focus on adult learning principles, competency-based education, collaborative learning, clinical learning by medical and nursing preceptors, experiential learning and self- directed learning. Education providers/preceptors/mentors must update their current knowledge and practices. Medical faculty are invited to participate as preceptors in the training. The Council also believes that a variety of educational strategies can be used in the clinical settings to address the deficit of qualified Family Health Nursing faculty. It is hoped to facilitate developing policies towards registration/licensure and create cadre positions for appropriate placement of these postgraduate NPs in Family Health to function in primary health care settings. An educational framework for the Nurse Practitioners in Family Health (NPFH) curriculum is proposed as under (See Figure 1). Figure 1. Nurse Practitioner in Family Health (NPFH) - An Educational Curricular Framework II. Program Description The Nurse Practitioner in Family Health (NPFH) program is a nursing residency program with a main focus on competency-based training. The duration is of two years with the curriculum consisting of theory that includes core courses, advanced practice courses and clinical courses besides clinical practicum which is a major component (Refer Curricular Framework in Figure 1). III. Aim The NPFH program prepares registered B.Sc. nurses for advanced practice roles such as clinical experts, managers, educators and consultants as nurse practitioners leading to M.Sc. Nursing (NP in Family Health). IV. Objectives On completion of the program, the NPFH will be able to 1. Assume responsibility and accountability to provide competent care to acutely and chronically ill patients and families using family centered approach in primary and secondary care centers/settings. 2. Demonstrate clinical competence/expertise in providing care which includes assessment, diagnostic reasoning, monitoring, therapies, home care and rehabilitation. 3. Apply theoretical, pathophysiological and pharmacological principles and evidence base in implementing care. 4. Assess and participate in treating patients with critical illnesses to stabilize and restore patient’s health and minimize or manage complications independently or collaboratively as a part of team. 5. Collaborate with other health care professionals in the team, across the continuum of care. V. Minimum requirements to start the Nurse Practitioner in Family Health (NPFH) Program The institution must accept the accountability for the NPFH program and its students and offer the program congruent with the Council standards. It must fulfill the following requirements: 1. Essentiality Certificate a. Any institution who wishes to start Nurse Practitioner in Family Health Program shall obtain an Essentiality Certificate/Government Order from the State. b. The following institutions are exempted from obtaining Essentiality Certificate: (i) Institutions/Universities already offering B.Sc. Nursing or M.Sc. Nursing programs and found suitable by the Council under Sections 13 and 14 of the Act; (ii) Institutions/Universities offering MBBS/DNB programs. 2. Clinical Facilities Minimum Bed Strength and Other Clinical Facilities • The hospital should be a tertiary care centre, with a minimum of 200 beds. • There should be well established department of community medicine/family medicine. • Adopted Community Health Areas - Rural/Urban/Tribal Settings - 30,000 population with a secondary health care facility. • Affiliated Rural Hospital/CHC/PHC and Health & Wellness Centre (Sub Centre). • Outpatient facilities to treat general illness, Communicable and Non-Communicable diseases, Pediatric, Obstetric, Gynecological and mental health conditions. • In patient facility for Pediatrics, Geriatrics, Communicable and Non-Communicable diseases, Obstetrical and Gynecological conditions. • Maternal and Neonatal units. • 8-10 level II neonatal beds. • Well established departments of general medicine and pediatrics. • Referral links to tertiary care hospital. • Affiliation with level III neonatal beds. • Special Clinics: RCH clinic, TB clinic, leprosy clinic, malaria clinic, diabetic clinic and psychiatric clinic. 3. Faculty/Staff Resources a. Clinical Area i. Nursing Preceptor: Full time qualified GNM with 6 years of experience in Primary Health Care/ Family Health Nursing or B.Sc. Nursing with 2 years’ experience in Primary Health Care/Family Health Nursing or M.Sc. (Specialty - Community Health Nursing, Medical Surgical Nursing/ Pediatric Nursing/Obstetrics & Gynecology Nursing) with one year of Primary Health Care/Family Health Nursing experience. ii. Medical Preceptor: Medical PG/Consultant in Family Medicine, Community Medicine and Pediatrics, Obstetrics, Geriatrics, General Medicine. iii. Preceptor Student Ratio: Nursing 1:10, Medical 1:10 (Every student must have a medical and a nursing preceptor). b. Teaching Faculty i. Professor/Associate Professor: 1 (Teaching experience: 5 years post PG-M.Sc. Specialty – Nurse Practitioner in Family Health (NPFH) / Community Health Nursing / Medical Surgical Nursing / Pediatric Nursing / Obstetrics & Gynecology Nursing) (One faculty for every 10 students). ii. Assistant Professor: 1 (M.Sc. Nursing with 3 years of teaching experience). c. The above faculty shall perform dual role or be a senior nurse with M.Sc. Nursing qualification in the specialty. d. Guest Lecturers for Pharmacology, Pathophysiology, Family Medicine. 4. Physical and Learning Resources at Hospital/College a. One class room/conference room at the clinical area. b. Skill lab for simulated learning (hospital/college). c. Library and computer facilities with access to online/offline journals. d. E-learning facilities. 5. List of equipment for Advanced Clinical Assessment/Community Health Nursing Skill Lab (Appendix 1a). 6. Student Recruitment/Admission Requirements a. Applicants must be a registered B.Sc./P.B.B.Sc. nurse with a minimum of one year clinical experience, preferably in any Community/Family Health Care setting prior to enrollment. b. Must have undergone B.Sc. Nursing in an institution found suitable by the Council and has been registered by the respective SNRC. c. Must have scored not less than 55% aggregate marks in the B.Sc. Nursing program. d. Selection must be based on the merit of an entrance examination and interview held by the competent authority. e. Must be physically fit. Number of Candidates: 1 candidate for one family care center serving 10,000 population or 4 candidates where there is a family medicine department with family medicine training, serving 40,000-50,000 population. Salary 1. In-service candidates will get regular salary. 2. Stipend/Salary for the other candidates as per the salary structure of the hospital where the program is conducted. VI. Examination Regulations Eligibility for appearing for the Examination Attendance: Minimum 80% for theory and practical before appearing for final University examination but must complete 100% in practical before the award of degree. There is no minimum cut off for internal assessment marks, as internal and external marks are added together for declaring pass. Examining and Degree Awarding Authority: Respective University. Declaration of Results The candidate is declared to have passed the exam if the score is 60% and above. This score is the aggregate of both internal and external University examination in theory and practical in every course/subject and less than 60% is fail. For calculating the rank, the aggregate of the two years’ marks will be considered. If a candidate fails in theory or practical, he/she must appear for the paper in which he/she has failed. Rank will not be declared for candidates who fail in any subject. Maximum period to complete the program is 4 years. Practical Examination OSCE type of examination is to be followed alongside viva (oral examination) - Refer OSCE Guidelines found in Appendix 2. Maximum number of students for practical exam per day is 10 students. Examination is to be held in clinical area only. The team of three practical examiners will include i. one internal examiner {M.Sc. Nursing faculty with two years of experiences in teaching the NPFH program/ M.Sc. Nursing faculty with specialty - Community Health Nursing (NPFH preferable) and with 5 years of post PG experience}. ii. one external examiner (same as above). iii. one medical internal examiner who should have served as preceptor for NPFH program. Dissertation* Research Guides: Main guide: Nursing faculty (3 years Post PG experience) teaching NPFH program, Co-guide: Medical preceptor. Submission of Research Proposal: 6-9 months after date of admission in the first year. Guide Student Ratio: 1:5 Research Committee: There shall be a separate research committee in the college/hospital to guide and oversee the progress of the research (minimum of 5 members with Principal or CNO who is M.Sc. Nursing qualified). Ethical Clearance must be obtained by the Institutional Review Board/Hospital Ethics Committee since it involves clinical research. Topic Selection: The topic should be relevant to Family Health Nursing that will add knowledge or evidence for nursing intervention. The research should be conducted in any of the family health care settings/primary or secondary care settings. Data Collection: 7 weeks are allotted for data collection, which can be integrated during clinical experience after 6 months in first year and before 6 months in second year. Writing the Research Report: 6-9 months in second year. Submission of Dissertation Final: 3 months before completion of the second year. Dissertation Examination Internal Assessment: Viva & Dissertation Report = 50 marks University Examination: Viva & Dissertation Report = 50 marks (Marking guide used for other M.Sc. Nursing specialties can be used for evaluation). *EBP project may be conducted in place of dissertation and report submitted for evaluation. VII. Assessment (Formative and Summative) • Quiz • Seminar • Written assignments/Term papers • Case/Clinical presentation • Clinical or care pathway/Case study report • Clinical performance evaluation • Log Book (Procedural Competency list and clinical requirements) counter signed by the medical/nursing faculty/preceptor • Objective Structured Clinical Examination (OSCE) • Test papers • Final examination (See Appendix 2 for Assessment Guidelines) Scheme of Final Examination S.No. Title Theory % Practical % Hours Internal External Hours Internal External Ist year Core Courses 1 Theoretical Basis for Advanced Practice Nursing 2 50 2 Research Application and Evidence-based Practice in Family Health Nursing 3 30 70 3 Advanced Skills in Leadership, Management and Teaching 3 30 70 Advanced Practice Courses 4 Advanced Pathophysiology & Advanced Pharmacology applied to Family Health Nursing 3 30 70 5 Advanced Health/Physical Assessment 3 30 70 50 50 IInd year Specialty Courses 1 Foundations of Family Health Nursing Practice 3 30 70 100 100 2 Family Health Nursing I 3 30 70 100 100 3 Family Health Nursing II 3 30 70 100 100 4 Dissertation/EBP Project and Viva 50 50 TOTAL = 2208 hours 288 (6 weeks) 144 (3 weeks) 1776 (37 weeks) Number of weeks available in a year = 52 - 6 (Annual leave, Casual leave, Sick leave = 6 weeks) = 46 weeks × 48 hours = 2208 hours (Examination during clinical posting) Two years = 4416 hours Instructional hours: Theory = 624 hours, Skill Lab = 240 hours, Clinical = 3552 hours TOTAL = 4416 hours Ist year: 336-96-1776 hours (Theory-Skill Lab-Clinical) [Theory = 15%, Practicum (Skill Lab & Clinical = 85%)] IInd year: 288-144-1776 hours (Theory-Skill Lab-Clinical) [Theory = 15%, Practicum = 85%] Ist year = 46 weeks/2208 hours (46 × 48 hours) (Theory + Lab: 7.5 hours per week for 44 weeks = 330/336+96 hours*) *Theory + Lab = 96 hours can be given for 2 weeks in the form of introductory block classes and workshops IInd year = 46 weeks/2208 hours (46 × 48 hours) (Theory + Lab: 8.5 hours per week for 45 weeks = 384+48 hours) (1 week Block Classes = 48 hours) CLINICAL PRACTICE A. Clinical Residency Experience A minimum of 48 hours per week is prescribed, however, it is flexible with different shifts and OFF followed by ON CALL duty in Secondary Health Care facility. B. 8 hours duty with one day OFF in a week and ON CALL duty once per week. Clinical Placements Ist year: 44 weeks (excludes 2 weeks of introductory block classes and workshop) • Medical wards - 10 weeks • Surgical wards - 6 weeks • Cardiology ward - 2 weeks • Oncology ward - 2 weeks • Neurology ward - 2 weeks • Nephrology ward - 2 weeks • Emergency department - 2 weeks • Rehabilitation unit - 2 weeks • Obstetrics wards - 2 weeks • Pediatric wards - 4 weeks (including 1 week of Pediatric Emergency Unit) • Intensive Care units - 4 weeks Outpatient Department (OPDs) • Pediatric OPD - 2 weeks • OG OPD - 2 weeks • Psychiatry OPD - 2 weeks IInd year: 45 weeks (excludes one week of block classes) • Emergency Department - 2 weeks • ICU - 2 weeks • Community Area for field practice (Home care) - 6 weeks o Urban - 2 weeks o Rural - 2 weeks o Tribal - 2 weeks • Outreach/Mobile Clinics - 2 weeks o Rural - 1 week o Urban - 1 week • Sub centers - 2 weeks • Primary Health Centers - 2 weeks • Community Health Centers - 2 weeks • District Hospital - 2 weeks • Out Patient Department (to include) - 3 weeks o Pediatric OPD - 1 week o OG OPD - 2 weeks • Secondary Health Care Facility/Community-based Hospital - 4 weeks • Communicable Disease Ward - 2 weeks • Palliative Care Centers and Hospice - 3 weeks • Labor Room - 3 weeks • Psychiatry wards - 2 weeks • Schools - 2 weeks • Occupational health units - 1 week • Geriatric ward/homes - 2 weeks • Field Visits - 3 weeks C. Teaching Methods Teaching: Theoretical, Lab & Clinical can be done in the following methods and integrated during clinical posting • Experiential learning • Reflective learning • Simulation • Clinical conference • Case/clinical presentation • In-depth drug study, presentation and report • Nursing rounds • Clinical seminars • Journal clubs • Case study/Clinical or care pathway • Advanced health assessment • Faculty lecture in the clinical area • Directed reading • Assignments • Case study analysis • Workshops • Epidemiological investigation • Disease surveillance • Clinical project • IEC activities • FGD - Using PRA D. Procedures/Log Book At the end of each Clinical Posting, Clinical Log Book (Specific Procedural Competencies/Clinical Skills) (Appendix 3) and Clinical Requirements (Appendix 4) have to be signed by the preceptor/faculty every fortnight. E. NPFH Competencies (Adapted from ICN, 2020) 1. Uses advanced comprehensive assessment, diagnosis, treatment planning, implementation and evaluation skills. 2. Applies and adapts advanced skills in complex and/or unstable environments. 3. Applies sound advanced clinical reasoning and decision making to inform, guide and teach in practice. 4. Documents assessment, diagnosis, management and monitors treatment and follow-up care in partnership with the patient. 5. Administer drugs and treatments according to institutional protocols. 6. Uses applicable communication, counseling, advocacy and interpersonal skills to initiate, develop and discontinue therapeutic relationships. 7. Refers to and accepts referrals from other health care professionals to maintain continuity of care. 8. Practices independently where authorized and the regulatory framework allows in the interest of the patients, families and communities. 9. Consults with and is consulted by other health care professionals and others. 10. Works in collaboration with health team members in the interest of the patient. 11. Develops a practice that is based on current scientific evidence and incorporated into the health management of patients, families and communities. 12. Uses research to produce evidence-based practice to improve the safety, efficiency and effectiveness of care through independent and inter-professional research. 13. Engages in ethical practice in all aspects of the APN role and responsibility. 14. Accepts accountability and responsibility for own advanced professional judgement, actions, and continued competence. 15. Creates and maintains a safe therapeutic environment through the use of risk management strategies and quality improvement. 16. Assumes leadership and management responsibilities in the delivery of efficient advanced practice nursing services in a changing health care system. 17. Acts as an advocate for patients in the health care systems and the development of health policies that promote and protect the individual patient, family and community. 18. Adapts practice to the contextual and cultural milieu. F. Scope of Practice The scope of practice for NPFH is fairly wide, as NPs in FH manages patients of all ages and often operate in primary/secondary care setting rather than specialized care setting. The scope of responsibility for a nurse practitioner may range from pediatric to geriatric care. Refer Appendix 6 for responsibilities of NPFH. G. Institutional Protocol/Standing Order-based administration of drugs & ordering of investigations and therapies The students will be trained to independently administer drugs and order diagnostic tests, procedures, medical equipment and therapies as per institutional protocols/standing orders (Appendix 5 Standing Orders). Administration of emergency drugs is carried out in consultation with concerned physician and endorsed later by written orders. Implementation of Curriculum - A Tentative Plan Ist year Courses Introductory Workshop Theory integrated Methods of Teaching Classes into Clinical (Topic can be specified) Practicum 1. Theoretical Basis for 8 hours 1×32=32 hours • Seminar/Theory Application Advanced Practice Nursing • Lecture (Faculty) (40) 2. Research Application and 8 hours 40 (5 days) 1×24=24 hours • Research Study Analysis/ Evidence-based Practice in +8 hours Exercise/Assignment (Lab) Family Health Nursing (56+24) 3. Advanced Skills in 12+2 hours 1×26=26 hours • Clinical Conference Leadership, Management (Block 2.5×16=40 hours • Seminar/Exercises/ Assignment and Teaching (56+24) classes) (Lab) 4. Advanced Pathophysiology 1.5×40=60 hours • Case Presentation applied to Family Health • Seminar Nursing (60) • Clinical Conference 5. Advanced Pharmacology 10 hours 1×44=44 hours • Nursing Rounds applied to Family Health • Drug Study Presentation Nursing (54) • Standing Orders/Presentation 6. Advanced Health/Physical 8 hours 2×26=52 hours • Clinical Demonstration Assessment (70+48) 1.5×18=27 hours (Faculty) 1×15=15 hours • Return Demonstration 2×6=12 hours • Nursing Rounds 2×2=4 hours • Physical Assessment (all systems) • Case Study TOTAL 48 hours 48 hours 336 hours Ist year: Introductory classes = 1 week (48 hours), Workshop = 1 week (48 hours), 44 weeks = 7.5 hours per week (330/336 hours) IInd year Courses Theory including Skill Lab Methods of Teaching 1 week Block Classes (48 hours)integrated into Clinical Practicum 1. Foundations of Family Health 9 hours × 16 weeks = 144 hours • Demonstration (Lab) Nursing Practice • Return Demonstration (Lab) (96+48) = 144 hours • Clinical Teaching • Case Study • Seminar • Clinical Conference • Faculty Lecture 2. Family Health Nursing 1 9 hours × 16 weeks = 144 hours • Demonstration (Lab) (96+48) = 144 hours • Return Demonstration (Lab) • Clinical Conference/Journal Club • Seminar • Case Presentation • Drug Study (including Drug Interaction) • Nursing Rounds • Faculty Lecture 3. Family Health Nursing II 9 hours × 16 weeks = 144 hours • Demonstration (Lab) (96+48) = 144 hours • Return Demonstration • Nursing Rounds • Clinical Conference/Journal Club • Seminar • Faculty Lecture IInd year: Block classes = 1 week, 45 weeks = 8.5/9 hours per week Topic for every teaching method will be specified in the detailed plan by the respective teacher/institution concerned. CORE COURSES I. Theoretical Basis for Advanced Practice Nursing COMPETENCIES 1. Analyses the global health care trends and challenges. 2. Analyses the impact of health care and education policies in India on nursing, consulting the documents available. 3. Develops in depth understanding of the health care delivery system in India, and its challenges. 4. Applies economic principles relevant to delivery of health care services in Family Health Nursing. 5. Manages and transforms health information to effect health outcomes such as cost, quality and satisfaction. 6. Accepts the accountability and responsibility in practicing the Nurse Practitioner’s roles and competencies. 7. Actively participates in collaborative practice, involving all health care team members in family health care and performs the prescriptive roles within the authorized scope. 8. Engages in ethical practice having a sound knowledge of law, ethics and regulation of advanced nursing practice. 9. Uses the training opportunities provided through well planned preceptorship and performs safe and competent care applying nursing process/care pathways or clinical pathways. 10. Applies the knowledge of nursing theories in providing competent family health nursing care to acutely and chronically ill people in various health care settings. 11. Predicts future challenges of Nurse Practitioner’s roles in variety of healthcare settings particularly in India. Hours of Instruction: Theory: 40 hours S.No. Topic Hours 1. Global Health Care Challenges and Trends (Competency 1) 2 2. Health System in India - Health Care Delivery System in India - Changing Scenario (Competency 3) 2 3. National Health Planning - 5-Year Plans and National Health Policy (Competency 2) 2 4. Health Economics & Health Care Financing (Competency 4) 4 5. Health Information System including Nursing Informatics (Use of Computers & Technology) (Competency 5) 4 Advanced Practice Nursing (APN) 6. APN - Definition, Scope, Philosophy, Accountability, Roles & Responsibilities (Collaborative Practice and Nurse Prescribing Roles) (Competency 6 & 7) 3 7. Regulation (Accreditation of Training Institutions and Credentialing) & Ethical Dimensions of Advanced Practice Nursing Role (Competency 8) 3 8. Nurse Practitioner - Roles, Types, Competencies, Clinical settings for Practice, Cultural Competence (Competency 6) 3 9. Training for NPs - Preceptorship (Competency 9) 2 10. Future Challenges of NP Practice (Competency 11) 4 11. Theories of Nursing applied to APN (Competency 10) 3 12. Nursing Process/Care Pathway applied to APN (Competency 9) 2 Self-Learning Assignments 6 1. Identify Health Care and Education Policies and analyze its impact on Nursing 2. Describe the legal position in India for NP practice. What is the future of nurse prescribing policies in India with relevance to these policies in other countries? 3. Examine the nursing protocols relevant to NP practice found in institutions inside and outside the country Total 40 hours Bibliography • AACN (2021) The Essentials: Core Competencies for Professional Nursing Education - Entry Level and Advanced Level Nursing Education, American Association of Colleges of Nursing • DeNisco & Barkers A.M. (2015) Advanced Practice Nursing: Essential Knowledge for the Profession (3rd ed.) Massachusetts: Jones & Bartlett Publishers Inc. • Hickey J.V., Ouimette R.M. & Venegoni S.L. (1996) Advanced Practice Nursing: Changing Roles and Clinical Applications, Philadelphia: Lippincott Williams & Wilkins • ICN (2020) Guidelines on Advanced Practice Nursing, Geneva: ICN • NONPF (2022) Nurse Practitioner Role Competencies, National Organization of Nurse Practitioner Faculties • Schober M. & Affara F.A. (2006) Advanced Nursing Practice, Oxford: Blackwell Publishing • Stewart G.J. & DeNisco S.M. (2015) Role Development for the Nurse Practitioner, USA: Springer Publishing Company II. Research Application and Evidence-based Practice in Family Health Nursing COMPETENCIES 1. Applies sound research knowledge and skills in conducting independent research in Family Health Nursing. 2. Participates in collaborative research to improve patient care quality. 3. Interprets and uses research findings in advanced practice to produce EBP. 4. Tests/evaluates current practice to develop best practices and health outcomes and quality care in advanced practice. 5. Analyzes the evidence for nursing interventions carried out in Family Health Nursing practice to promote safety and effectiveness of care. 6. Develops skill in writing scientific research reports. Hours of Instruction: Theory: 56 hours + Lab/Skill Lab: 24 hours = 80 hours S.No. Topic Hours 1. Research and Advanced Practice Nursing 2 Significance of research and inquiry related to advanced nursing role (Competency 1) 2. Research Agenda for APN Practice Testing current practice to develop best practice, health outcomes and indicators of quality care in advanced practice (Competency 3, 4, 5), promoting research culture 5 3. Research Knowledge and Skills Research competencies essential for APNs (interpretation and use of research, evaluation of practice, participation in collaborative research) Introduction to Evidence Based Practice (EBP) project - PiCOT question, steps of planning, implementation, evaluation and dissemination (project proposal and project report) Research Methodology Phases/steps (Research question, review of literature, conceptual framework, research designs, sampling, data collection, methods & tools, Analysis and Reporting) Writing research proposal and research report (Competency 1 & 2) 40 (5 days workshop) 4. Writing for Publication (Writing workshop - Manuscript preparation and finding funding sources) (Competency 6) 5 (workshop) 5. Evidence-based Practice - Concepts, principles, importance and steps - Integrating EBP to Family Health Nursing care settings - Areas of evidence in Family Health Nursing care - Barriers to implement EBP - Strategies to promote EBP (Competency 3, 4, 5) 4 Total 56 hours Lab/Skill Lab & Assignments: 24 hours • Identifying research priorities • Writing exercises on research question, objectives and hypothesis • Writing research proposal • Scientific paper writing - preparation of manuscript for publication • Writing systematic review/literature review - Analyze the evidence for a given nursing intervention in family health care settings. Practicum • Research Practicum: Dissertation ( 336 hours = 7 weeks)/Evidence Based Practice Project (EBP project) Bibliography • Gray J. & Grove S.K. (2020) The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence (9th ed.) St. Louis: Elsevier Saunders • Polit D.F. & Beck C.T. (2021) Nursing Research: Generating and Assessing Evidence for Nursing Practice (11th ed.) New Delhi: Wolters & Kluwer • Schmidt N.A. & Brown J.M. (2021) Evidence-based Practice for Nurses Appraisal and Application of Research, Sd: Jones & Bartlett Publishers Inc. III. Advanced Skills in Leadership, Management and Teaching COMPETENCIES 1. Applies principles of leadership and management in Family Health Care settings. 2. Manages stress and conflicts effectively in a Family Health Nursing setting using sound knowledge of principles. 3. Applies problem solving and decision-making skills effectively. 4. Uses critical thinking and communication skills in providing leadership and managing patient care in primary and secondary care/family health care settings. 5. Builds teams and motivates others in family health care. 6. Develops unit budget, manages supplies and staffing effectively. 7. Participates appropriately in times of innovation and change. 8. Uses effective teaching methods, media and evaluation based on sound principles of teaching. 9. Develops advocacy role in patient care, maintaining quality and ethics in Family Health Care settings. Hours of Instruction: Theory: 56 hours + Lab/Skill Lab: 24 hours = 80 hours S.No. Topic Hours 1. Theories, styles of leadership and current trends 2 2. Theories, styles of management and current trends 2 3. Principles of leadership and management applied to Family Health Care settings 4 4. Stress management and conflict management - principles and application to primary care environment, effective time management 4 5. Quality improvement and audit 4 6. Problem solving, critical thinking and decision making, communication skills applied to family health nursing practice. 5 7. Team building, motivating and mentoring within family health care settings 2 8. Budgeting and management of resources including human resources - budget, material management, staffing, assignments 5 9. Change and innovation 2 10. Staff performance, and evaluation (performance appraisals) 6 11. Teaching-learning theories and principles applied to Family Health Nursing 2 12. Competency-based education and outcome-based education 2 13. Teaching methods/strategies, media: educating patients, families and staff in Family Health Care settings 8 14. Staff education and use of tools in evaluation 4 15. APN - Roles as a teacher 2 16. Advocacy roles in Family Health Care settings 2 Total 56 hours Lab/Skill Lab: 24 hours • Preparation of staff patient assignment • Preparation of unit budget • Preparation of staff duty roster • Patient care audit • Preparation of nursing care standards and protocols • Management of equipment and supplies • Monitoring, evaluation, and writing report of infection control practices • Development of teaching plan • Micro teaching/patient education sessions • Preparation of teaching method and media for patients and staff • Planning and conducting OSCE/OSPE • Construction of tests Assignment: Work place violence/Mob violence Bibliography • Bastable S.B. (2019) Nurse as Educator: Principles of Teaching and Learning for Nursing Practice (5th ed.) New Delhi: Jones & Bartlett Publishers Inc. • Billings D.M. & Halstead J.A. (2019) Teaching in Nursing: A Guide for Faculty (6th ed.) St. Louis Missouri: Saunders Elsevier • Clark C.C. (2010) Creative Nursing Leadership and Management, New Delhi: Jones & Bartlet Publishers Inc. • Liebler J.G. & McConnel C.R. (2008) Management Principles for Health Professionals, Sudbury M.A.: Jones & Bartlett Publishers Inc. • Roussel L. & Swansburg R.C. (2010) Management and Leadership for Nurse Administrators (5th ed.) New Delhi: Jones & Bartlett Publishers Inc. ADVANCED PRACTICE COURSES IV. A. Advanced Pathophysiology applied to Family Health Nursing COMPETENCIES 1. Integrates the knowledge of pathophysiological process in acute and chronic conditions in developing diagnosis and plan of care. 2. Applies the pathophysiological principles in symptom management, primary and secondary prevention of acute and chronic illnesses. 3. Analyzes the pathophysiological changes relevant to each acute and chronic illness recognizing the value of diagnosis, treatment, care and prognosis. Hours of Instruction: Theory: 30 hours Unit Hours Content I 8 Cardiovascular function Advanced pathophysiological process of cardiovascular conditions • Hypertensive disorder • Peripheral artery disorder • Venous disorders • Coronary artery diseases • Valvular heart disease • Cardiomyopathy and heart failure • Cardiac tamponade • Arrythmias • Corpulmonale • Heart block and conduction disturbances II 4 Pulmonary function Advanced pathophysiological process of pulmonary conditions • Chronic obstructive pulmonary disease • Disorders of the pulmonary vasculature • Infectious diseases • Respiratory failure • Chest trauma III 6 Neurological function Advanced pathophysiological process of neurological conditions • Seizure disorder • Cerebrovascular disease • Infections • Spinal cord disorder • Degenerative neurological diseases • Neurological trauma • Coma, unconsciousness IV 4 Renal function Advanced pathophysiological process of renal conditions • Acute renal failure • Chronic renal failure • Bladder trauma • Infections (Glomerulonephritis) • Nephrotic syndrome V 4 Gastrointestinal and hepatobiliary function Advanced pathophysiological process of hepatobiliary conditions • Gastrointestinal bleeding • Intestinal obstruction • Pancreatitis • Hepatic failure • Gastrointestinal perforation VI 4 Endocrine functions Advanced pathophysiological process of endocrine conditions • Diabetic ketoacidosis • Hyperosmolar nonketotic coma • Hypoglycemia • Thyroid storm • Myxedema coma • Adrenal crisis • Syndrome of inappropriate antidiuretic hormone secretion Total 30 hours IV. B. Advanced Pathophysiology applied to Family Health Nursing Hours of Instruction: Theory: 30 hours Unit Hours Content I 8 Hematological function Advanced pathophysiological process of hematological conditions • Disorders of red blood cells - Polycythemia - Anemia - Sickle cell diseases • Disorders of white blood cells - Leucopenia - Neoplastic disorders • Disorders of hemostasis - Platelet disorders - Coagulation disorders - Disseminated intravascular coagulation II 2 Integumentary function Advanced pathophysiological process of integumentary conditions • Wound healing • Burns • Steven Johnson syndrome III 8 Multisystem dysfunction Advanced pathophysiological process of multisystem dysfunction • Shock - Hypovolemic - Cardiogenic - Distributive • Systemic inflammatory syndrome • Multiple organ dysfunction syndrome • Trauma - Thoracic - Abdominal - Musculoskeletal - Maxillofacial • Drug overdose and poisoning • Envenomation IV 6 Specific infections Advanced pathophysiological process of specific infections • HIV • Tetanus • SARS • Rickettsiosis • Leptospirosis • Dengue • Malaria • Chikungunya • Rabies • Avian flu • Swine flu V 6 Reproductive functions Advanced pathophysiological process of reproductive conditions • Antepartum hemorrhage • Pregnancy induced hypertension • Obstructed labor • Ruptured uterus • Postpartum hemorrhage • Puerperal sepsis • Amniotic fluid embolism • HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) • Trauma Total 30 hours Bibliography • Berkowitz A. (2021) Clinical Pathophysiology (2nd ed.) MedMaster Inc. • Huether S.E., McCance K.L. & Brashers V.L. (2019) Understanding Pathophysiology (7th ed.) St. Louis, Missouri: Elsevier • Norris T.L. (2020) Porth’s Essentials of Pathophysiology (5th ed.) Walters & Kluwer • Porth C.M. (2014) Essentials of Pathophysiology: Concepts of Altered Health States (4th ed.) Philadelphia: Lippincott Williams & Wilkins • Story L. & Dlugasch L. (2019) Advanced Pathophysiology for the Advanced Practice Nurse (1st ed.) Jones & Bartlett Publishers Inc. • Willis L.M. (2019) Professional Guide to Pathophysiology (4th ed.) LWW V. Advanced Pharmacology applied to Family Health Nursing COMPETENCIES 1. Applies the pharmacological principles in providing care to acutely and chronically ill patients and families. 2. Analyzes pharmacotherapeutics and pharmacodynamics relevant to drugs used in the treatment of acute and chronic diseases. 3. Performs safe drug administration based on principles and institutional protocols/standing orders. 4. Documents accurately and provides follow up care. 5. Applies sound knowledge of drug interactions in administration of drugs to acutely and chronically ill patients in the family health care settings and guiding their families in self-care management. Hours of Instruction: Theory: 54 hours Unit Hours Content I 2 Introduction to Pharmacology in Family Health Nursing • History • Classification of drugs and schedules • Institutional Protocols/Standing Orders in Family Health Care II 4 Pharmacokinetics and Pharmacodynamics • Introduction • Absorption, distribution, metabolism, and excretion of drugs • Plasma concentration, half-life • Loading and maintenance dose • Therapeutic index and drug safety • Potency and efficacy • Principles of drug administration ▪ The rights of drug administration ▪ Systems of measurement ▪ Drug administration: Enteral, topical, and parenteral III 5 Pharmacology and Cardiovascular alterations in Family Health Nursing • Vasoactive medications ▪ Vasodilator ▪ Vasopressor ▪ Inotropes - Cardiac glycosides - digoxin - Sympathomimetics - dopamine, dobutamine, epinephrine, isoproterenol, norepinephrine, phenylephrine - Phosphodiesterase inhibitors - amrinone, milrinone • Antiarrhythmic medications • Medications in the management of cardiac critical care conditions • Medications to improve cardiac contractility ▪ Hypertension in critical care ▪ Heart failure ▪ Angina pectoris and myocardial infarction ▪ Dysrhythmias, heart block and conduction disturbances ▪ Pulmonary hypertension, valvular heart disease, cardiomyopathy ▪ Atherosclerotic disease of aorta and peripheral artery disease ▪ Deep vein thrombosis IV 4 Pharmacology and Pulmonary alterations in Family Health Nursing • Mechanical ventilation • Introduction • Medications used on patients with mechanical ventilator • Mechanical ventilation impact on pharmacotherapy - sedation and analgesia, neuromuscular blockade, nutrition • Medications in the management of pulmonary critical care conditions ▪ Status asthmaticus ▪ Pulmonary edema ▪ Pulmonary embolism ▪ Acute respiratory failure and Acute Respiratory Distress Syndrome (ARDS) ▪ Chest trauma ▪ Chronic obstructive pulmonary disease ▪ Pneumonia ▪ Pleural effusion ▪ Atelectasis • Standing Orders for pulmonary emergencies V 6 Pharmacology and Neurological alterations in Family Health Nursing • Pain ▪ NSAID ▪ Opioid analgesia • Sedation ▪ Gamma amino butyric acid stimulants ▪ Dexmedetomidine ▪ Analogizations • Delirium ▪ Haloperidol ▪ Atypical antipsychotics • Medications used for local and general anesthesia ▪ Local - amides, esters, and miscellaneous agents ▪ General - gases, volatile liquids, IV anesthetics ▪ Non anesthetic drugs adjuncts to surgery • Paralytic medications ▪ Non-depolarizing and depolarizing agents ▪ Anxiolytics • Autonomic drugs ▪ Adrenergic agents/sympathomimetics ▪ Adrenergic blocking agents ▪ Cholinergic agents ▪ Anti-cholinergic agents • Medications in the management of anxiety and insomnia ▪ Antidepressants ▪ Benzodiazepines ▪ Barbiturates • Medications in the management of neurological critical care conditions ▪ Psychoses ▪ Acute head and spinal cord injury with elevated intracranial pressure ▪ Muscle spasm ▪ Spasticity ▪ Cerebrovascular disease and Cerebrovascular accident ▪ Encephalopathy ▪ Gillian Bare syndrome and myasthenia gravis ▪ Brain herniation syndrome ▪ Seizure disorder ▪ Coma, unconsciousness and persistent vegetative state ▪ Appropriate nursing care to safeguard patient • Standing Orders for neurological emergencies VI 5 Pharmacology and Nephrology alterations in Family Health Nursing • Diuretics • Fluid replacement ▪ Crystalloids ▪ Colloids • Electrolytes ▪ Sodium ▪ Potassium ▪ Calcium ▪ Magnesium ▪ Phosphorus • Medication in the management of nephrology critical care conditions ▪ Acute/Chronic renal failure ▪ Acute tubular necrosis ▪ Bladder trauma ▪ Electrolyte imbalances ▪ Acid base imbalances ▪ Medications used during dialysis • Standing Orders for nephrology emergencies VII 5 Pharmacology and Gastrointestinal alterations in Family Health Nursing • Anti-ulcer drugs • Laxatives • Anti-diarrheal • Anti-emetics • Pancreatic enzymes • Nutritional supplements, vitamins and minerals • Medications in the management of gastrointestinal critical care conditions ▪ Acute GI bleeding, hepatic failure ▪ Acute pancreatitis ▪ Abdominal injury ▪ Hepatic encephalopathy ▪ Acute intestinal obstruction ▪ Perforative peritonitis ▪ Medications used during gastrointestinal surgeries and liver transplant • Standing Orders for gastrointestinal emergencies VIII 4 Pharmacology and Endocrine alterations in Family Health Nursing • Hormonal therapy • Insulin and other hypoglycemic agents • Medications in the management of endocrine critical care conditions ▪ Diabetic ketoacidosis, hyperosmolar non-ketonic coma ▪ Hypoglycemia ▪ Thyroid storm ▪ Myxedema coma ▪ Adrenal crisis ▪ SIADH • Standing Orders for endocrine emergencies IX 5 Pharmacology and Hematology alterations in Family Health Nursing • Anticoagulants • Antiplatelet drugs • Thrombolytics • Haemostatics, antifibrinolytics • Hematopoietic growth factors ▪ Erythropoietin ▪ Colony stimulating factors ▪ Platelet enhancers • Blood and blood products ▪ Whole blood, packed red blood cells, leukocyte-reduced red cells, washed red blood cells, fresh frozen plasma, cryoprecipitate ▪ Albumin ▪ Transfusion reactions, transfusion administration process • Vaccines • Immunostimulants • Immunosuppressant • Chemotherapeutic drugs - alkylating agents, anti-metabolites, anti-tumor antibiotics, alkaloids, hormones and hormone antagonist, corticosteroids, gonadal hormones, anti-estrogens, androgen antagonists, biologic response modifiers • Medications in the management of hematology critical care conditions ▪ Anemia in critical illness ▪ DIC ▪ Thrombocytopenia and acute leukemia ▪ Heparin induced thrombocytopenia ▪ Sickle cell anemia ▪ Tumor lysis syndrome X 3 Pharmacology and Skin alterations in Family Health Nursing • Hematology critical care conditions ▪ Medications used in burn management ▪ Medications used in wound management XI 5 Pharmacology and Multisystem alterations in Family Health Nursing • Medications in the management of shock, sepsis, multiple organ dysfunction, systemic inflammatory response syndrome, anaphylaxis • Medications in the management of trauma, injuries (heat, electrical, near hanging, near drowning) • Medications in the management of bites, drug overdose and poisoning • Medications in the management of fever in critical care setting ▪ Antipyretics ▪ NSAIDS ▪ Corticosteroids XII 6 Pharmacology and Infections in Family Health Nursing • Anti-bacterial drugs ▪ Introduction ▪ Beta lactams - penicillin, cephalosporins, monobactams, carbapenems ▪ Aminoglycosides ▪ Anti MRSA ▪ Macrolides ▪ Quinolones ▪ Miscellaneous - lincosamide group, nitroimidazole, tetracycline and chloramphenicol, polymyxins, and anti-malarial, anti-fungal, anti-viral drugs • Choice of antimicrobials • Infectious critical care conditions ▪ Medications in the management of HIV, Tetanus, SARS, Rickettsiosis, Leptospirosis, Dengue, Malaria, Chikungunya, Rabies, Avian flu and Swine flu Total 54 hours Bibliography • Eisen H.J. (2020) Pharmacology of Immunosuppression (1st ed.) Springer • McKay G.A. & Walters M.R. (2021) Clinical Pharmacology and Therapeutics (10th ed.) Wiley-Blackwell • Tripathi K.D. (2019) Essentials of Medical Pharmacology (8th ed.) Jaypee Brothers Medical Publishers, New Delhi • Wynne A.L., Woo T.M. & Olyaei A.J. (2007) Pharmacotherapeutics for Nurse Practitioner Prescribers (2nd ed.) Philadelphia: Davis VI. Advanced Health/Physical Assessment COMPETENCIES 1. Applies the physical assessment principles in developing appropriate system wise examination skills. 2. Uses advanced health assessment skills to differentiate between variations of normal and abnormal findings. 3. Orders screening and diagnostic tests based on the examination findings and institutional protocols. 4. Analyzes the physical examination findings and results of various investigations and works collaboratively with General Medicine/Community Medicine/Family Medicine physicians for development of diagnoses. 5. Documents assessment, diagnosis, and management and monitors follow up care in partnership with health care team members, patients, and families. Hours of Instruction: Theory: 70 hours + Lab/Skill Lab: 48 hours = 118 hours Unit Hours Content I 4 Introduction • History taking • Physical examination II 6 Cardiovascular system • Cardiac history • Physical examination • Cardiac laboratory studies - biochemical markers, hematological studies • Cardiac diagnostic studies - electrocardiogram, echocardiography, stress testing, radiological imaging III 6 Respiratory system • History • Physical examination • Respiratory monitoring - arterial blood gases, pulse oximetry, end-tidal carbon dioxide monitoring • Respiratory diagnostic tests - chest radiography, ventilation perfusion scanning, pulmonary angiography, bronchoscopy, thoracentesis, sputum culture, pulmonary function test IV 6 Nervous system • Neurological history • General physical examination • Assessment of cognitive function • Assessment of cranial nerve function • Motor assessment - muscle strength, power, and reflexes • Sensory assessment - dermatome assessment • Neurodiagnostic studies - CT scan, MRI, PET V 6 Renal system • History • Physical examination • Assessment of renal function • Assessment of electrolytes and acid base balance • Assessment of fluid balance VI 4 Gastrointestinal system • History • Physical examination • Nutritional assessment • Laboratory studies - liver function studies, blood parameters, stool test • Diagnostic studies - radiological and imaging studies, endoscopic studies VII 4 Endocrine system • History • Physical examination • Laboratory studies and diagnostic studies of ▪ Hypothalamus and pituitary gland ▪ Thyroid gland ▪ Parathyroid gland ▪ Endocrine gland ▪ Adrenal gland VIII 4 Hematological system • History • Physical examination • Laboratory studies - blood parameters • Diagnostic studies - bone marrow aspiration IX 3 Integumentary system • History • Physical examination • Pathological examination - tissue examination X 6 Musculoskeletal system • History • Physical examination - gait assessment, joint assessment, • Laboratory studies - blood parameters (inflammatory enzymes, uric acid) • Diagnostic studies - radiological and imaging studies, endoscopic studies XI 5 Reproductive system (Male & Female) • History • Physical examination • Laboratory studies • Diagnostic studies XII 4 Sensory Organs • History • Physical examination • Laboratory studies • Diagnostic studies - radiological and imaging studies, endoscopic studies XIII 6 Assessment of children • Growth and development • Nutritional assessment • Specific system assessment XIV 6 Assessment of older adults • History • Physical assessment • Psychological assessment Total 70 hours List of skills to be practiced in the skill lab (48 hours include demonstration by the faculty and practice by the students) ▪ Comprehensive history taking ▪ Focused history taking (system wise) ▪ Comprehensive physical examination ▪ Focused physical examination (system wise) ▪ Monitoring clinical parameters (system wise) Invasive BP monitoring, Multi-parameter Monitors, ECG, Pulse index Continuous Cardiac Output (PiCCO), Peripheral vascular status, ABG, Pulse Oximetry, End Tidal CO2 (ETCO2), Intracranial Pressure (ICP), Glasgow Coma Scale (GCS), Cranial nerve assessment, Pain and Sedation score of critically ill, Motor assessment, Sensory assessment, Renal function tests, Fluid balance, acid base balance, electrolytes, Bowel sounds, Abdominal pressure, Residual gastric volume, Liver function tests, GRBS, Lab tests, Radiological and Imaging tests (system wise) ▪ Interpretation of screening and diagnostic tests (system wise) ▪ Assessment of children - neonate and child ▪ Assessment of older adults ▪ Assessment of pregnant women Bibliography • Bickley L.S. & Szilagyi P.G. (2018) Bates’ guide to physical examination and history taking, South Asian edition, Wolters Kluwer India Pvt. Ltd. • Rhoads J. (2013) Advanced health assessment and diagnostic reasoning (2nd ed.) Philadelphia: Lippincott Williams & Wilkins • Wilson S.F. & Giddens J.F. (2021) Health assessment for nursing practice (7th ed.) Elsevier: Health Sciences Division FAMILY HEALTH NURSING SPECIALTY COURSES (Foundations of Family Health Nursing Practice, Family Health Nursing I and Family Health Nursing II) COMPETENCIES 1. Applies advanced concepts of Family Health Nursing based on sound knowledge of these concepts. 2. Uses invasive and noninvasive technology and interventions to assess, monitor and promote physiologic stability. 3. Works in collaboration with other health care team members and prepares care/clinical pathways in assessment and management of patients with acute and chronic conditions. 4. Consults with and is consulted by other health care professionals. 5. Provides nursing care related to health protection, disease prevention, anticipatory guidance, counseling, management of critical illness, palliative care and end of life care. 6. Uses advanced skills in complex and unstable environments. 7. Applies ethically sound solutions to complex issues related to individuals, populations and systems of care. 8. Practices principles of infection control relevant to Family Health Nursing. 9. Practices independently within the legal framework of the country towards the interest of patients, families and communities. 10. Develops practice that is based on scientific evidence. 11. Uses applicable communication, counseling, advocacy and interpersonal skills to initiate, develop and discontinue therapeutic relationships. 12. Creates and maintains a safe therapeutic environment using risk management strategies and quality improvement. 13. Adapts practice to the social, cultural and contextual milieu. VII. Foundations of Family Health Nursing Practice Hours of Instruction: Theory: 96 hours + Lab/Skill Lab: 48 hours = 144 hours Unit Hours Content I 10 Introduction to Family Health Nursing Practice • Introduction to the course • Review of anatomy and physiology of vital organs (Brain, Spinal Cord, Lungs, Heart, Kidney, Liver, Pancreas, Thyroid, Adrenal and Pituitary gland) • Historical review - Nurse Practitioner in Family Health • Concepts and principles of Family Health Nursing Practice • Scope of Family Health Nursing Practice • Family Health Nursing Practice Settings (including rural, urban, slum and tribal, equipment, supplies, and the environment) • Personnel in the team ▪ Nursing staff ▪ Ancillary staff ▪ Health workers/ANM/Health volunteers ▪ Social worker ▪ Counsellors ▪ Health education ▪ Socio-economic development workers ▪ Family medicine physicians • Use of appropriate technology • Healthy work environment • Future challenges in Family Health Nursing Practice II 5 Concept of Holistic Care applied to Family Health Nursing Practice • Application of nursing process and integrated care/clinical pathways in the care of acutely and chronically ill • Definition of family • Functions of family and its structure • Family demography • Approaches of family health nursing • Theories of family health nursing • Family health risk assessment • Eco map • Development and family lifestyle • Lifestyle risk and assessment • Behavioral risk • Environmental risk • Social risk III 10 Appraisal of the Acutely and Chronically Ill Triaging concept, process and principles Assessment of the acutely and chronically ill • General assessment • Respiratory assessment • Cardiac assessment • Renal assessment • Neurological assessment • Gastrointestinal assessment • Endocrine assessment • Musculoskeletal assessment • Integumentary assessment Monitoring of the acutely and chronically ill • Hemodynamics • Electrocardiography (ECG) • Glasgow Coma Scale (GCS) • Richmond Agitation Sedation Scale (RASS) • Pain score • Braden score Evaluation of the acutely and chronically ill • Evaluation of acute illness • Evaluation of chronic illness • Outcome and scoring systems ▪ Acute Physiology and Chronic Health Evaluation (APACHE I-IV) ▪ Mortality probability model (MPM I, II) ▪ Simplified acute physiology score (SAPS I, II) ▪ Organ system failure ▪ Full outline of unresponsiveness (FOUR) ▪ Model for end-stage liver disease (MELD) IV 14 Advanced Concepts and Principles of Family Health Nursing • Principles of cardio-pulmonary-brain resuscitation • Emergencies in Primary and Secondary Health Care: CPR ▪ BLS ▪ ACLS • Airway management • Oxygenation and oximetry, care of patient with oxygen delivery devices • Ventilation and ventilator support (including humidification and inhaled drug therapy), care of patient with invasive and non-invasive ventilation • Circulation and perfusion (including hemodynamic evaluation and waveform graphics) • Fluids and electrolytes (review), care of patient with imbalances of fluid and electrolytes • Evaluation of acid base status • Thermoregulation, care of patient with hyper/hypothermia • Glycemic control, care of patient with glycemic imbalances V 8 Pain and Management • Pain in patients • Pain - types, theories • Physiology, systemic responses to pain and psychology of pain - Review • Acute pain services • Pain assessment - pain scales, behavior and verbalization • Pain management - pharmacological (opioids, benzodiazepines, propofol, alpha agonist, tranquilizers, neuromuscular blocking agents) • Nonpharmacological management • Transcutaneous electrical nerve stimulation (TENS) VI 8 Psychosocial and Spiritual alterations: Assessment and Management • Stress and psychoneuroimmunology • Post-traumatic stress reaction • Psychosis, anxiety, agitation, delirium • Alcohol withdrawal syndrome and delirium tremens • Collaborative management • Sedation and relaxants • Spiritual challenges in critical care • Coping with stress and illness • Care of family of the acutely and chronically ill • Counseling and communication VII 5 Patient and Family Education and Counseling • Challenges of patient and family education • Process of adult learning • Factors affecting teaching learning process • Informational needs of families in Family Health Nursing • Counseling needs of patient and family • Counseling techniques VIII 5 Nutrition alterations and Management in Family Health Nursing • Nutrient metabolism and alterations • Assessing nutritional status • Nutrition support • Nutrition and systemic alterations • Care of patient on enteral and parenteral nutrition IX 4 Sleep alterations and Management • Normal human sleep • Sleep pattern disturbance • Sleep apnea syndrome X 5 Infection Control in Hospital/Health Center • Nosocomial infection; methyl resistant staphylococcus aureus (MRSA) and other recently identified strains • Disinfection, sterilization • Standard safety measures/universal precautions • Prophylaxis for staff • Antimicrobial therapy - review • Biomedical waste management XI 6 Legal and Ethical Issues in Family Health Nursing – Nurses’ Role Legal issues • Issues giving raise to civil litigation • Related laws in India • Medical futility • Administrative law: Professional regulation • Tort law: Negligence, professional malpractice, intentional torts, wrongful death, defamation, assault and battery • Constitutional Law: Patient decision making Ethical issues • Difference between morals and ethics • Ethical principles, ethical decision making in critical care, strategies for promoting ethical decision making Ethical issues relevant to critical care • Withholding and withdrawing treatment • Managing scarce resource • Brain death, organ donation & counseling • Do Not Resuscitate (DNR), Euthanasia, Living will • Nurses’ Role XII 8 Quality Assurance • Design of health center/hospital • Quality assurance models • Standards, Protocols, Policies, Procedures • Infection control policies and protocols • Nursing audit • Staffing • Indian Public Health Standards • NQAS XIII 3 Evidence-based Practice in Family Health Nursing • Evidence based practice in family health critical care • Barriers to implementation • Strategies to promote implementation 5 Class tests Total 96 hours List of skills to be practiced in the skill lab (48 hours include demonstration by the faculty and practice by the students) • Lifestyle risk and assessment • Behavioral risk assessment • Environmental risk • Triaging • Nutritional assessment • CPR (BLS and ACLS) • Airway Management o Laryngeal mask airway o Cuff inflation and anchoring the tube o Care of ET tube o Tracheostomy care o Suctioning - open/closed o Chest physiotherapy • Oxygenation and oximetry, care of patient with oxygen delivery devices o Devices to measure oxygen/oxygenation ▪ Fuel cell ▪ Para magnetic oxygen analyzer ▪ PO2 electrodes - Clark electrodes ▪ Transcutaneous oxygen electrodes ▪ Oximetry - Pulse oximetry, Venous oximetry o Capnography o Non-invasive ventilation ▪ Low flow variable performance devices: nasal catheters/cannulae/double nasal prongs, face mask, face mask with reservoir bags ▪ High flow fixed performance devices: Entrainment (Venturi) devices, NIV/CPAP/Anesthetic masks, T pieces, breathing circuits o Postural drainage • Ventilation and ventilator support o Connecting to ventilator o Weaning from ventilator o Extubation o Humidifiers o Nebulizers - jet, ultrasonic o Inhalation therapy - metered dose inhalers (MDI), dry powder inhalers (DPI) • Circulation and perfusion (including hemodynamic evaluation and waveform graphics) o Invasive blood pressure monitoring o Non-invasive blood pressure monitoring o Venous pressure (Peripheral, Central and Pulmonary artery occlusion pressure) o Intravenous line starting and infusion o Insertion and removal of arterial line o Insertion and removal of central line o Pulse index Continuous Cardiac output (PiCCO) o Electrocardiography (ECG) o Waveforms • Fluids and electrolytes o Fluid calculation and administration (crystalloids and colloids) o Administration of blood and blood products o Inotrope calculation, titration and administration ▪ Cardiac glycosides - digoxin ▪ Sympathomimetics - dopamine, dobutamine, epinephrine, isoproterenol, norepinephrine, phenylephrine ▪ Phosphodiesterase inhibitors - amrinone, milrinone o Electrolyte correction (sodium, potassium, calcium, phosphorus, magnesium) o Use of fluid dispenser and infusion pumps • Evaluation of acid base status o Arterial blood gas (ABG) • Thermoregulation, care of patient with hyper/hypothermia o Temperature probes o Critical care management of hyper and hypothermia • Glycemic control, care of patient with glycemic imbalances o Monitoring GRBS o Insulin therapy (sliding scale and infusion) o Management of hyperglycemia - IV fluids, insulin therapy, potassium supplementation o Management of hypoglycemia - Dextrose IV • Pharmacological management of pain, sedation, agitation, and delirium o Calculation, loading and infusion of - Morphine, Fentanyl, Midazolam, Lorazepam, Diazepam, Propofol, Clonidine, Dexmedetomidine, Haloperidol o Epidural analgesia - sensory and motor block assessment, removal of epidural catheter after discontinuing therapy, change of epidural catheter site dressing, insertion and removal of subcutaneous port for analgesic administration, intermittent catheterization for urinary retention for patients on epidural analgesia/PCA, dose titration for epidural infusion, epidural catheter adjustment, purging epidural drugs to check patency of catheter and also for analgesia ▪ Counseling - Individual, Family and Group ▪ Family education ▪ Biomedical waste management VIII. Family Health Nursing I Hours of Instruction: Theory: 96 hours + Lab/Skill Lab: 48 hours = 144 hours Unit Hours Content I 10 Maternal and Women’s Health • Review of anatomy and physiological changes • Assessment, diagnosing and treating diseases specific to women • Common women health problems • Reproductive and child health o Pregnancy ▪ Normal changes ▪ Pregnancy related problems/obstetric complications ▪ Preconception, antenatal, intranatal and postnatal care ▪ Maternal Mortality o Family Planning - Contraception, MTP • Insertion of IUCDs and Removal • Sexual health, STIs including genital tract infections • Genital tract malignancies, prevention, screening, and early treatment - Pap test, VIA • Perimenopause, Menopause, Post menopause • Common disorders of reproductive system • Mental health • Social issues - Substance abuse, Sexual abuse, Violence • Women health education • Women and Nutrition II 15 Primary Care of Adult • Review of anatomy and physiology • Assessment, diagnosing and treating of common diseases • Recent advances and development • Common adult health problems o Cardiovascular problems o Respiratory diseases o Gastroenterological diseases o Genitourinary disorders o Musculoskeletal disorders o Neurological disorders o Nutritional Disorders - Prevention and Management o Poisoning III 15 Primary Care of Well Child • Review of anatomy and physiology • Normal growth and development • Care of newborn • Breast feeding problems and management • Recognition and referral of common birth anomalies • Immunization • Child abuse and injury prevention • Assessment, diagnosis and treatment of common diseases - Infants, Pre-schooler & School going children o Common childhood infections o Child nutrition & nutrition disorders including obesity o School readiness, sleep problems o Physical activity and exercises o Children with special needs o Cardiovascular problems o Respiratory diseases o Gastroenterological disorders o Genitourinary disorders o Musculoskeletal disorders o Neurological disorders • Common childhood cancers - screening and management • Common pediatric emergencies • IMNCI (Review) IV 15 Primary Care of Adolescents • Pubertal changes - male and female • Common Adolescent health problems - assessment, diagnosis and management • Nutrition & Exercises Adolescent Risk Assessment • Sexual health • Behavioral problems, stress and psychosocial problems • Adolescents and laws (POSH etc.) • Adolescent counselling V 25 Communicable Diseases • Review of communicable diseases • Common communicable diseases - assessment, diagnosis and management of o Air borne diseases o Water borne diseases o Food borne diseases o Vector borne diseases o Vehicle borne diseases o Emerging and re-emerging diseases • Preventive measures • Epidemiology of communicable diseases • National programs related to communicable diseases VI 11 Community Health relevant for Family Health Nursing • Concept of health and disease, primary health care and its implementation • Epidemiology and epidemiological methods - epidemiology of communicable and non- communicable diseases • Management of epidemics and pandemics • Management of disaster • Environmental health • Health care delivery system • National health programs and policies • School health • Demography and family planning • Health information and health statistics • Health insurance schemes - National and Private • Role of NGOs 5 Class tests Total 96 hours List of skills to be practiced in the skill lab (48 hours include demonstration by the faculty and practice by the students) • Older adult assessment o History o Physical examination o Nutritional assessment o ADL assessment o Fragility assessment & fall risk assessment o Psychosocial assessment o Diagnostic tools: Geriatric depression scale, mini cog test, CAM ICU scale • Mini nutritional assessment • Therapeutic diet planning • Mental health survey & screening • Home based care of mentally ill • Testicular Self Examination (TSE) • Smoking cessation sessions • Podiatric care • End of life care • Pain assessment and scoring - WHO ladder, VAS • Pain management of palliative client • Grief counseling • Vision screening • Oral examination • National health programs on NCD prevention and control - knowledge and participation The skills listed under the specialty courses such as Foundations of Family Health Nursing Practice, Family Health Nursing I and Family Health Nursing II are taught by the faculty in skill lab. The students after practicing them in the lab, will continue to practice in the respective hospital/health centers. The log book specifies all the requirements to be completed and the list of skills are to be signed by the preceptor/faculty once the students develop proficiency in doing the skills independently. Recommended Reference Books • Abilash K.P.P. (2019) Emergency Medicine, Best Practices at CMC (EMAC) (2nd ed.) Jaypee Brothers Publications • Adelman D.S. & Timothy J. Legg (2011) Disaster Nursing: A Handbook for Practice, Springer Publishing Co., New York • Arulraj S., Jayalal J.A., Abdul Hasan K.M. & Ravishanker T.N. (2017) Text Book of Family Medicine (3rd ed.) Elsevier • Butler J. Thomas (2000) Principles of Health Education and Health Promotion (3rd ed.) Wadsworth Publishing Co. Inc. • Cash Jill & Glass Cherya (2019) Adult Gerontology Guidelines (2nd ed.) Springer Publication, New York • Clement-Stone, Susan (2002) Comprehensive Family & Community Health Nursing: Family, Aggregate and Community Practice (6th ed.) St. Louis: Mosby Inc. • Dash B. (2023) A Comprehensive Text Book of Community Health Nursing (2nd ed.) Jaypee Brothers Medical Publishers Pvt. Ltd. • Fenstermacher K. & Hudson B.T. (2024) Practice Guidelines for Family Nurse Practitioners (6th ed.) Elsevier • Hockenberry Marilyn J., Rodgers Cheryl C. & Wilson David (2022) Wong’s Essentials of Pediatric Nursing (11th ed.) St. Louis: Elsevier • Hockenberry Marilyn J., Duffy Elizabeth A. & Gibbs Karen Divalerio (2024) Wong’s Nursing Care of Infants and Children (12th ed.) St. Louis: Elsevier • Ian D. Penman, Stuart H. Ralston, Mark W.J. Strachan & Richard P. Hobson (2022) Davidsons Principle and Practice of Medicine (24th ed.) Elsevier • Jacob A. (2023) A Comprehensive Text Book of Midwifery & Gynecological Nursing (6th ed.) Jaypee Brothers Medical Publishers • Karen Fenstermacher & Barbara Toni Hudson (2020) Practice Guidelines for Family Nurse Practitioners (5th ed.) Elsevier Publication, St. Louis • Kaakinen J.R. (2009) Family Health Care Nursing Theory Practice and Research (4th ed.) Davisfa • Kishore J. (2022) National Health Programmes of India: National Policies and Legislations related to Health (14th ed.) New Delhi: Century Publications • Kiralal Konar (2023) D.C. Dutta’s Text Book of Obstetrics: Including Perinatology and Contraception (10th ed.) Jaypee Brothers • Loscalzo Fauci, Kasper Hauser & Longo (2022) Harrison’s Principles of Internal Medicine (21st ed.) Vol. 1, Mc Graw Hill • Marshall J. & Raynor M. (2020) Myles Text Book for Midwives (17th ed.) Elsevier • Ministry of Health & Family Welfare (2022) Indian Public Health Standards for Community Health Centers, retrieved from https://nhsrcindia.org/sites/default/files/CHC%20IPHS%202022%20Guidelines%20pdf.pdf • Ministry of Health & Family Welfare (2022) Indian Public Health Standards for Primary Health Centers. Vol. II, retrieved from https://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines 2022/03_PHC_IPHS_Guidelines-2022.pdf • Ministry of Health & Family Welfare (2012) Indian Public Health Standards for Health Sub Centers, Vol. II, retrieved from https://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2012/sub-centers.pdf • Park K. (2023) Park’s Textbook of Social and Preventive Medicine (27th ed.) Banarsidas Bhanot • Stanhope M. & Lancaster J. (2024) Public Health Nursing (11th ed.) • Singh Meharban (2021) Care of the Newborn (9th ed.) New Delhi: CBS Publishers & Distribution Pvt. Ltd. • Stanhope M. & Lancaster J. (2019) Public Health Nursing: Population Centered Health Care in the Community (10th ed.) Evolve • Suresh K., Sharma S. & Madhavi (2022) Brunner & Suddaarth’s Text Book of Medical Surgical Nursing, Vol. 2 (14th ed.) South Asian Edition, Wolters Kluwer • Videbeck L.S. (2019) Psychiatric Mental Health Nursing, Philadelphia: Lippincott Williams and Wilkins • Vinod K. Paul & Arvind Bagga (2023) GHAI Essential Pediatrics (10th ed.) CBS Publishers Pvt. Ltd. • Thornboy Greta (2014) Contemporary Occupational Health Nursing, A Guide to Practitioners, Routledge, T & F Group, UK APPENDIX 1a SKILL LAB REQUIREMENTS Note: In addition to the basic skill lab requirement of College of Nursing, the following are necessary: S.No. Skill Lab Requirements No. Skill 1. Adult manikin - male 2 Health assessment 2. Adult manikin - female with reproductive system 3 3. Bed with mattress 5 4. Linen set 5 5. Blood pressure apparatus 10 6. Weighing scale 10 7. Height scale 10 8. Nutritional assessment cups 10 sets Nutritional assessment and preparation of nutritional diet 9. Vessels for nutritional demonstration (cups, spoons, plates, pans etc.) 5 sets 10. Gas stove 2 11. Cylinder 2 12. IEC materials 13. Poster 10 Preparation and use of IEC materials 14. Pamphlets 10 15. Flannel graph 10 16. Flash card 10 17. Flip chart 10 18. Slide projector 1 19. LCD projector 1 20. PA system 1 21. Laptop 1 22. Chalk board 1 23. Glass slides 10 Diagnostic procedures 24. Syringes 20 25. Needles 20 26. Vacutainers 20 27. Trays 20 28. Needle dispenser 20 29. Alcohol based swabs 20 30. Venipuncture and injection training arm 1 31. Models Pelvic examination model 1 Child birth simulator 1 Episiotomy simulator 1 New born manikin resuscitation simulator 1 IUCD insertion model 1 Injection training arm simulator for intradermal & subcutaneous injections 1 Baby dummy for vaccination 1 32. Personal protective equipment 4 set Infection control 33. Hand washing area 2 34. Biomedical waste disposal unit 1 35. Vaginal examination model Pelvic examination tray Artery clamp - 1 Artery forceps-1 Bowl - 1 Cotton ball - few Zephiran solution 4 Vaginal examination 36. Pelvic examination table 1 37. Pelvic examination model Speculum examination 38. Pelvic examination table 39. Sims/Bivalve speculum 1 40. Spot light 1 41. Child birth simulator Conduction of normal deliveries 42. Delivery set Scissors 1 Needle holder 1 Artery forceps/clamps 1 Dissecting forceps 1 Sponge forceps 1 Vaginal speculum 1 Apron/drapes 1 Goggle 1 Face mask 1 Gown 1 Sterile gloves 1 Cord tie 1 Sterile cotton Few Bowls 2 4 43. Episiotomy training simulator Episiotomy and suturing 44. Episiotomy set Episiotomy scissors - 1 Needle holder - 1 Needle - 1 Suture materials - 1 Bowl - 1 4 45. Pelvic examination model IUCD insertion and removal 46. Pelvic examination tray 47. Intrauterine device 4 48. New born manikin with resuscitation simulator Essential new born care and new born resuscitation 49. Syringes 4 Vaccine administration 50. Needles 4 51. Trays 4 52. Needle dispenser 1 53. Sharps container 1 54. Samples of vaccine 1 set 55. Alcohol based swabs 20 56. Injection training arm simulator for intradermal & subcutaneous injections 57. Baby dummy for vaccination 58. Vaccine container 1 59. . Ostomy Care set 1 60. Foot Care set 1 61. 6 Tablets for data recording 5 Digital recording 62. Reports - daily, weekly, monthly, annual, sentinel, birth, death 20 Recording & reporting APPENDIX 1b EQUIPMENT LIST FOR A SECONDARY HOSPITAL 1. Adjustable cot with mattress - 10 2. IV stand - 20 3. Bed side locker - 11 (10 - patients; 1 - stock) 4. Over bed trolley - 10 5. Dressing trolley (Small) - 5 6. Dressing trolley (medium) - 2 7. Syringe pump - 10 8. Infusion pump - 10 9. Monitors- 11 (10 - patients; 1- stock) 10. Transport monitor/pulse oximeter - 2 11. Ventilators - 1 12. Portable ventilators - 1 13. ABG machine - 1 14. ECG machine - 1 15. Ultrasound machine - 1 16. Doppler machine - 1 (if vascular patients are admitted in ICU) 17. Defibrillator - 1 18. Peripheral Nerve Stimulator - 1 19. Blood warmer - 3 20. Patient warmer - 5 21. Sequential Compression Device - 10 22. Alpha mattress with motor - 15 23. LEAD shield - 1 24. Crash cart - 1 25. Transfer trolley - 4 26. OR trolley - 2 27. Safe slider - 2 28. Computer - 4 29. Printers - 2 30. Bain circuit - 12 31. Oxygen flowmeter - 10 32. Suction port with jar - 10 33. Air flowmeter/pulmoaid - 10 34. Refrigerator - 2 35. Metal foot step/foot stool - 10 36. Ambulation chair - 5 37. UPS - 1 38. Flat trolley - 1 39. Spot light - 2 40. Glucometer - 2 41. Ambu bag with different sizes - 10 sets 42. Trays with sterile sets/disposable sets for various procedures (e.g. insertion of central venous catheter, tracheostomy etc.) APPENDIX 1c EQUIPMENT LIST FOR CHC - Refer Annexure 10 of the Indian Public Health Standards for Community Health Centers (2022) by Ministry of Health & Family Welfare Vol. II, p. 132, retrieved from https://nhsrcindia.org/sites/ default/files/CHC%20IPHS%202022%20Guidelines%20pdf.pdf EQUIPMENT LIST FOR PHC - Refer Annexure 7 & 8 of the Indian Public Health Standards for Primary Health Centers (2022) by Ministry of Health & Family Welfare Vol. II, p. 118, retrieved from https://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2022/03_PHC_IPHS_Guidelines-2022.pdf EQUIPMENT LIST FOR SUB-CENTERS - Refer the Indian Public Health Standards for Health Sub Centers (2012) by Ministry of Health & Family Welfare Vol. II, p. 16, retrieved from https://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2012/sub-centers.pdf APPENDIX 2 ASSESSMENT GUIDELINES (including OSCE Guidelines) INTERNAL ASSESSMENT (Theory and Practical) Ist year 1. Theoretical Basis for Advanced Practice Nursing College examination of theory only: 50 marks Internal Assessment: Test paper/Quiz: 10 marks Written assignment/term paper: 10 marks (Global and national health care trends & policies) Clinical seminar: 5 marks (Clinical/Care pathway in specific clinical condition/Application of specific nursing theory) Final theory college exam: 25 marks Total: 50 marks 2. Research Application and Evidence-based Practice in Family Health Nursing Theory: Test papers: 20 marks Written assignment: 5 marks (Literature review/Preparation of research instrument) Journal club: 5 marks (Analysis of research evidence for Family Health Nursing competencies) Total: 30 marks 3. Advanced Skills in Leadership, Management and Teaching Theory: Test papers: 15 marks Journal club: 5 marks (Trends in Leadership/management/teaching) Written assignment: 5 marks (Ex. work place violence) Microteaching: 5 marks Total: 30 marks 4. Advanced Pathophysiology & Advanced Pharmacology applied to Family Health Nursing Theory: Test papers and Quiz: 20 marks (Pathophysiology - 10, Pharmacology - 10) Drug studies: 5 marks (Drug study and presentation) Case presentation and case study report (Pathophysiology): 5 marks Total: 30 Marks 5. Advanced Health/Physical Assessment Theory: Test papers: 20 marks Written assignment: 10 marks (Diagnostic/investigatory reports - interpretation and analysis of findings) Total: 30 marks Practicum: Clinical performance evaluation: 10 marks End of posting exam (OSCE): 10 marks Case presentation and case study report: 5 marks Internal OSCE: 25 marks Total Internal practical: 50 marks End of posting exam can be conducted in secondary hospital/health center IInd year 1. Foundations of Family Health Nursing Practice Theory: Test papers and Quiz: 20 Written assignment: 10 marks (Health Center protocols) Total: 30 marks Practicum: Clinical Performance evaluation: 20 marks End of posting exam (OSCE): 10 marks Drug studies (Drug study and presentation): 10 marks Case presentation and case study report (Family education/counseling): 5 marks Case presentation (Application of Clinical/Care Pathway): 5 marks Internal OSCE: 50 marks Total Internal practical: 100 marks 2. Family Health Nursing I Theory: Test papers and Quiz: 20 marks Clinical seminar and Journal club: 10 marks Total: 30 marks Practicum: Clinical performance evaluation: 20 marks End of posting exam (OSCE): 10 marks Clinical presentation: 10 marks Case study report: 10 marks Internal OSCE: 50 marks Total Internal practical: 100 marks 3. Family Health Nursing II Theory: Test papers: 20 marks Clinical Seminar: 10 marks Total: 30 marks Practicum: Clinical performance evaluation: 20 marks End of posting exam (OSCE): 10 marks Clinical presentation: 10 marks Case study report (developed clinical/care pathway): 10 marks Internal OSCE: 50 marks Total Internal practical: 100 marks End of posting exam can be conducted in any secondary hospital/health center 4. Dissertation Practicum: 50 marks EXTERNAL (FINAL) EXAMINATION (As per schedule in syllabus) Theory: Short answer and essay type questions (Weightage can be decided by the University) {Essay 2×15 marks = 30, Short answers 5×6 marks = 30, Very short 5×2 marks = 10} OSCE GUIDELINES FOR INTERNAL AND EXTERNAL PRACTICAL EXAMINATION Ist year I. ADVANCED HEALTH/PHYSICAL ASSESSMENT INTERNAL OSCE: 25 marks CORE COMPETENCY DOMAINS TO BE EXAMINED 1. Focused history taking and physical examination of adult patient 2. Focused history taking and physical examination of pediatric patient 3. Interpretation of history and physical examination findings 4. Interpretation of results of lab and diagnostic tests 5. Monitoring of clinical parameters Number of stations: 5 (4+1 Rest station) Time for each station: 10 minutes Marks for each station: 5 marks (As per competency check list and allotted marks) Total: 4×5 = 20 marks Oral exam = 5 marks Total = 25 marks EXTERNAL OSCE: 50 marks CORE COMPETENCY DOMAINS 1. Focused history taking of adult patient 2. Focused physical examination of adult patient 3. Focused history taking of pediatric patient 4. Focused physical examination of pediatric patient 5. Interpretation of history and physical exam findings 6. Interpretation of results of lab and diagnostic tests 7. Monitoring clinical parameters Number of stations: 10 (8+2 Rest stations) Time for each station: 10 minutes Marks for each station: 5 marks (As per competency check list and allotted marks) Total: 8×5 = 40 marks Oral exam = 10 marks Total = 50 marks On completion of procedural competencies in log book and clinical requirements, the NP student is qualified to appear for final practical examination. IInd year I. FOUNDATIONS OF FAMILY HEALTH NURSING PRACTICE INTERNAL OSCE: 50 Marks CORE COMPETENCY DOMAINS TO BE EXAMINED 1. Focused history taking, physical examination and interpretation of findings & results of adult patient 2. Focused history taking, physical examination and interpretation of findings & results of pediatric patient 3. Monitoring competencies (invasive and noninvasive) 4. Development of care plan 5. Therapeutic interventions including drug administration across the lifespan 6. Emergency procedural competencies 7. Family education and counseling 8. Family centered care Number of stations: 5 (4+1 Rest station) Time for each station: 10 minutes Marks for each station: 10 marks (As per competency check list and allotted marks) Total: 10×4 = 40 marks Oral exam = 10 marks Total = 50 marks EXTERNAL OSCE: 100 marks CORE COMPETENCY DOMAINS 1. Focused history taking, physical examination and interpretation of findings & results of adult patient 2. Focused history taking, physical examination and interpretation of findings & results of pediatric patient 3. Monitoring competencies (invasive and noninvasive) 4. Development of care plan 5. Family education and counseling 6. Therapeutic interventions including drug administration across the lifespan 7. Family centered care Number of stations: 10 (8+2 Rest stations) Time for each station: 10 minutes Marks for each station: 10 marks (As per competency check list and allotted marks) Total: 8×10 = 80 marks Oral exam = 20 marks Total = 100 marks FAMILY HEALTH NURSING I & II INTERNAL OSCE:50 marks CORE COMPETENCY DOMAINS 1. Focused history taking, physical examination and interpretation of results of adult patient 2. Focused history taking, physical examination and interpretation of results of pediatric patient 3. Women’s health - assessment and specific procedures 4. Monitoring competencies (invasive and noninvasive) 5. Development of care plan/care pathway 6. Family education and counseling 7. Therapeutic interventions including drug administration across the lifespan 8. Infection control practices 9. Family centered care Number of stations: 5 (4+1 Rest station) Time for each station: 10 minutes Marks for each station: 10 marks (As per competency check list and allotted marks) Total: 10×4 = 40 marks Oral exam = 10 marks Total = 50 marks EXTERNAL OSCE: 100 marks CORE COMPETENCY DOMAINS 1. Focused history taking, physical examination and interpretation of results of adult patient 2. Focused history taking, physical examination and interpretation of results of pediatric patient 3. Monitoring competencies (invasive and noninvasive) 4. Women’s health - assessment and specific procedures 5. Development of care plan 6. Family education and counseling 7. Therapeutic interventions including drug administration across the lifespan 8. Infection control practices 9. Family centered care Number of stations: 10 (8+2 Rest stations) Time for each station: 10 minutes Marks for each station: 10 marks (As per competency check list and allotted marks) Total: 8×10 = 80 marks Oral exam = 20 marks Total = 100 marks On completion of procedural competencies in log book and clinical requirements, the NP student is qualified to appear for final practical examination APPENDIX 3 CLINICAL LOG BOOK FOR NURSE PRACTITIONER IN FAMILY HEALTH (NPFH) - POSTGRADUATE RESIDENCY PROGRAM (Specific Procedural Competencies/Clinical Skills) Ist year S.No. Specific Competencies/Skills Number Date Signature of the Performed/Assisted/Observed Preceptor*/Faculty (P/A/O) I RESEARCH APPLICATION AND EVIDENCE BASED PRACTICE 1 Preparation of research instrument 2 Writing systematic review/literature review 3 Preparation of a manuscript for publication (Ist or IInd year) 4 Dissertation/EBP project (IInd year) Topic: II LEADERSHIP, MANAGEMENT AND TEACHING 1 Preparation of staff patient assignment 2 Preparation of unit budget 3 Preparation of staff duty roster 4 Patient care audit in the unit 5 Management of equipment and supplies 6 Monitoring, evaluation, and writing report related to infection control 7 Preparation of teaching plan and media for teaching patients/staff 8 Micro teaching/patient education sessions 9 Planning and conducting OSCE/OSPE 10 Construction of tests III HEALTH ASSESSMENT 1 Comprehensive history taking 2 Focused history taking (system wise) 3 Comprehensive physical examination 4 Focused physical examination (system wise) 4.1 Respiratory system 4.2 Cardiac system 4.3 Gastrointestinal 4.4 Nervous - Mental Status Examination, Cranial Nerve Assessment 4.5 Genitourinary 4.6 Endocrine 4.7 Hematological 4.8 Musculoskeletal 4.9 Integumentary 4.10 Sensory organs - vision & hearing 5 Age specific history & physical examination 5.1 Neonate 5.2 Child 5.3 Adult 5.4 Geriatric 6 History & physical examination of a pregnant woman IV DIAGNOSTIC TESTS/PROCEDURES 1 Collecting blood sample for laboratory tests and inferring result 1.1 Biochemistry 1.2 Clinical pathology 1.3 Microbiology 1.4 ABG 2 Assisting procedures 2.1 Paracentesis 2.2 Thoracentesis 2.3 Lumbar puncture 2.4 Liver biopsy 2.5 Renal biopsy 2.6 Bone marrow aspiration 3 Witnessing procedures 3.1 PET scan 3.2 Endoscopy 3.3 MRI/CT 3.4 Ultrasound 3.5 Echocardiogram 4 Monitoring and interpretation of critical parameters 4.1 Arterial Blood Gas (ABG) 4.2 Oxygen saturation 4.3 Endotracheal tube cuff pressure 4.4 Capnography 4.5 Hemodynamics 4.6 Electrocardiogram (ECG) 4.7 Intracranial pressure (ICP) 4.8 Invasive BP monitoring 4.9 Non-invasive BP monitoring 4.10 PiCCO (Pulse index Continuous Cardiac Output) 4.11 Peripheral vascular status 4.12 Glasgow Coma Score 4.13 Sedation Score 4.14 Pain Score 4.15 Braden Score 4.16 Bowel sounds 4.17 GRBS 4.18 Chest X-Ray V. BASIC COMPETENCIES 1 Admission 2 Transfer 3 Transport 4 Referral to higher center 5 Discharge/LAMA 6 Setting up, use and maintenance of basic critical care equipment 6.1 Monitor/s 6.2 Transducer/pressure bag 6.3 Temperature probes 6.4 SpO2 probes 6.5 CTG machine 6.6 12-lead ECG monitor 6.7 Blood/Fluid Warmer 6.8 Syringe pump 6.9 Infusion pump 6.10 Phototherapy 6.11 Oxygen cylinder and manifold system 6.12 Alpha/Air mattress * - When the student is found competent to perform the skill, it will be signed by the preceptor. Students: Students are expected to perform the listed skills/competencies many times until they reach level 3 competency, after which the preceptor signs against each competency. Preceptors/Faculty: Must ensure that the signature is given for each competency only after they reach level 3. • Level 3 Competency denotes that the NP student is able to perform that competency without supervision. • Level 2 Competency denotes that the student is able to perform each competency with supervision. • Level 1 Competency denotes that the student is not able to perform that competency/skill even with supervision. Signature of the Program Coordinator/Faculty Signature of the HOD/Principal CLINICAL EXPERIENCE DETAILS Name of the Area Clinical Condition Number of days Signature of care given Faculty/Preceptor APPENDIX 5 STANDING ORDERS AND PROTOCOLS Nurse Practitioners in Family Health are prepared and qualified to assume responsibility and accountability for the care of patients across the life span. They collaborate with family medicine physicians, primary care physicians and specialists to ensure accurate therapy for patients with high acuity needs. On completion of the program, the Nurse Practitioners will be permitted to administer drugs listed in standing orders as per the institutional standing orders. They will also be permitted to order diagnostic tests/procedures and therapies as per institutional protocols. STANDING ORDERS The following intravenous injections or infusions may be administered by the Nurse Practitioner during emergency. Catecholamines 1. Adrenaline 2. Vasopressin Antidysrhythmic 3. Amiodarone Adrenergic agent 4. Ephedrine Bronchodilators 5. Aminophylline 6. Deriphylline 7. Tiova Antihistamine 8. Avil Antihypertensives 9. Glycerine trinitrate Corticosteroid 10. Hydrocortisone Antiepileptic 11. Levitracetam Sedatives & relaxants 12. Valium Electrolytes & acid base correction agents 13. Soda bicarbonate 8.4% 14. Soda bicarbonate 7.5% 15. 3% normal saline 16. 0.9% normal saline 17. Antipyretics 18. Anti Parkinson’s drugs Repeat medications 19. Calcium supplements - Sandacol, Shelcal, Osteocalcium 20. Oral antidiabetic agents - Metformin, Glynase, Insulin Additional Standing Orders for Home-based Care (Refer GoI protocols) The following investigations and therapies may be ordered by the Nurse Practitioners Ordering Investigations Ordering Therapies ▪ ECG ▪ Nebulization ▪ ABG ▪ Chest physiotherapy ▪ Chest X ray ▪ Distal colostomy wash ▪ Basic Biochemistry investigations - Hb, PCV, ▪ Insertion and removal of urinary catheter for female patients TIBC, WBC Total, WBC differentials, ESR, ▪ Test feeds Electrolytes, platelets, PT, aPTT, bleeding and ▪ TEDS clotting time, procalcitonin, D-dimer, creatinine, ▪ Surgical dressing HbA1c, AC, PC, HDL, LDL, TIG, Cholesterol ▪ Starting and closing dialysis total, HIV, HbsAg, HCV, ▪ Application of ichthammol glycerin/magnesium sulphate INSTITUTIONAL STANDING ORDERS AND PROTOCOLS In every hospital, the standing orders for drug administration with specific dosage to be administered during emergency situations can be made available as guidelines for NPFH graduates. The NP students will be trained to administer these drugs under supervision by preceptors/NP faculty. The protocols for ordering selected investigations and carrying out specific therapeutic procedures can also be available in every hospital that trains NPFH students. APPENDIX 6 RESPONSIBILITIES OF NPFH 1. Evaluating and diagnosing patients: Nurse Practitioners in Family Health perform physical examinations, collect medical histories, and diagnose their patients. 2. Screening and disease prevention: Success as a family nurse practitioner requires the use of health screenings and evaluations, helping with early detection of chronic or acute conditions such as cancer, diabetes, or cardiovascular disease. 3. Developing and implementing treatment plans: Once a diagnosis has been made, the family nurse practitioner formulates an effective treatment, which may include lifestyle changes, pharmaceutical intervention, physical therapy, or a referral to a specialist. 4. Management of chronic conditions: In the course of their practice, family nurse practitioners will likely have patients who struggle with chronic conditions, such as diabetes, arthritis, or inflammation. Part of their job is helping patients learn to cope with and manage these conditions. 5. Patient education: The NPFH also advise patients on how to live healthy lifestyles and minimize their risk of illness. This might include nutritional coaching or tips on effective stress management. When treating children or adolescents, nurse practitioners in family health must also communicate care plans to parents or guardians. 6. Conducting research: The clinical practice of Nurse Practitioner in Family Health may be augmented with experimental work or other forms of research, helping to deepen their understanding of effective patient care. 7. Public health advocacy: The NPFH who work in community clinics or acute care facilities may be responsible for promoting healthy living within the community. 8. Collaboration with other professionals: In some care contexts, advanced practice nurses may work in collaboration with physicians, partnering to provide high standards of care. The NPFH must also be prepared to refer their patients to relevant specialists, such as substance abuse coaches, mental health care providers, oncologists, etc. Specific Responsibilities of NPs in FH 1. Preconception and prenatal care 2. Well-woman and illness care 3. Well-child and illness care 4. Episodic care for acute illnesses for all ages, including minor acute injuries 5. Management of chronic conditions such as hypertension, diabetes, asthma, etc. 6. Monitoring and co-management of primary care conditions with a specialist for potentially unstable conditions such as cardiac diseases and neuromuscular conditions 7. Case management for any long-term illness or condition and rehabilitation Dr. T. DILEEP KUMAR, President, INC [ADVT.-III/4/Exty./843/2024-25] Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054. RAVINDER KUMAR Digitally signed by RAVINDER KUMAR Date: 2025.01.03 11:48:56 +05'30'