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

REGD. No. D. L.-33004/99 The Gazette of India EXTRAORDINARY PART III—Section 4 PUBLISHED BY AUTHORITY No. 1082] NEW DELHI, FRIDAY, DECEMBER 27, 2024/PAUSHA 6, 1946 CG-DL-E-06012025-259945 INDIAN NURSING COUNCIL NOTIFICATION New Delhi,18th December 2024 INDIAN NURSING COUNCIL {NURSE PRACTITIONER IN NEONATAL NURSING (NPNeoN) - POSTGRADUATE RESIDENCY PROGRAM} REGULATIONS, 2024 F.No. 11-1/2024-INC (VIII):—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 Neonatal Nursing (NPNeoN) - 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 NEONATAL NURSING (NPNeoN) - POSTGRADUATE RESIDENCY PROGRAM I. Introduction and Background Ensuring healthy survival of all neonates has clearly emerged as a key area for improving child health. The global community has committed itself to attain an under-five child mortality of less than 20 per 1000 lives birth in all countries by 2035. According to the World Health Organization estimates, there is an alarmingly low level of trained health personnel in many of the developing countries. The Ayushman Bharat Scheme launched by the Government of India intended to address health care with two major components: Health and Wellness Centre (HWC) and National Health Protection Scheme. Though the intent of the program to upgrade the health system is expected to achieve the goal of Health for All, there is no evidence of a skilled health workforce in numbers for effective implementation. Considering the scale of importance, a skilled health workforce tops the pyramid of health care delivery systems. The government recognizes significant expansion in tertiary care services both in public and private health sectors. In building their capacity, it is highly significant that the health care professionals require advanced educational preparation in specialty and super-specialty services. To support specialized and super-specialized health care services, specialist nurses with advanced preparation are essential. Developing training programs and curriculum in the area of tertiary care is recognized as the need of the hour. Nurse Practitioners (NPs) will be able to meet this demand provided they are well trained and empowered to practice. With establishment of new cadres in the Center and State level, master level prepared NPs will be able to provide cost effective, competent, safe and quality driven specialized nursing care to neonates in a variety of neonatal care units in tertiary care centres. Nurse Practitioners have been prepared and functioning in USA since 1960s, UK since 1980s, Australia since 1990s and Netherlands since 2010. Nurse Practitioners in Neonatal Nursing (NPNeoN) can be prepared to function in tertiary care settings. Rigorous educational preparation will enable them to collaboratively diagnose and treat neonates with critical illnesses both for prevention and promotion of health. A curricular structure/framework is proposed by the Council towards preparation of the Nurse Practitioner in Neonatal Nursing (NPNeoN) at master’s 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), Council of International Neonatal Nurses (CoINN) Competencies (2021) and National Organization of Nurse Practitioner Faculties (NONPF, 2022). Every course is based on achievement of competencies. Nurse Practitioner in Neonatal Nursing (NPNeoN) – Residency Program is intended to prepare registered B.Sc. Nurses to provide advanced nursing care to neonates who are critically ill. The nursing care is focused on stabilizing neonate’s condition, minimizing acute complications and maximizing optimal neuro developmental outcomes. More than 80% of all newborn deaths result from three preventable and treatable conditions - intrapartum-related deaths (including birth asphyxia), complications due to prematurity and neonatal infections. Cost-effective, proven interventions exist to prevent and treat each main cause. Improving quality of care around the time of birth will save the most lives, but it requires competent health workers and availability of essential infrastructure. These Neonatal NPs are required to practice in neonatal care units of tertiary care centers and SNCUs. 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 independently administer drugs and order diagnostic tests, procedures, medical equipment and therapies as per institutional protocols. The Neonatal NP when exercising this authority, they are accountable for the competencies in - a) Neonate selection/admission into Neonatal Care Units (NCUs) and discharge; b) Problem identification through appropriate assessment; c) Selection/administration of medication or devices or therapies; d) Strengthen and invest in care during labor, birth and the neonatal period; e) Improve the quality of maternal and neonatal care; f) Neonate’s parental/care giver empowerment for use of therapeutics; g) Knowledge of interactions of therapeutics, if any; h) Evaluation of outcomes; and i) Recognition and management of complications and untoward reactions. The Neonatal NP is prepared and qualified to assume responsibility and accountability for the care of critically ill neonates 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 Neonatal Nursing (NPNeoN) to meet the challenges and demands of tertiary health care services in India, which is reflected in the National Health Policy, 2017 to provide quality care to critically ill neonates and families. 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 experience with 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 Neonatal Nursing faculty. It is hoped to facilitate developing policies towards registration/licensure and create cadre positions for appropriate placement of these postgraduate Neonatal NPs to function in neonatal care units of tertiary care centers. An educational framework for the Nurse Practitioner in Neonatal Nursing (NPNeoN) curriculum is proposed as follows (See Figure 1). Figure 1. Nurse Practitioner in Neonatal Nursing (NPNeoN) - An Educational Curricular Framework Registered B.Sc. Nurse with 1-year Clinical Experience preferably in Neonatal Nursing Setting (Entry requirement) +---------------------------+----------------------------------------------------------------+-----------------+ | Strong | | | | Clinical | | | | Component | | | | (Clinical Residency) | | | +---------------------------+----------------------------------------------------------------+-----------------+ | Competency Based | Theory-15% | Advanced | | Education and | | Knowledge | | Training | I. Core Courses | and Ethics | | | +--------------------------------------------------------------+-----------------+ | | | • Theoretical Basis for Advanced Practice Nursing | • Advanced | | | | • Research Application and Evidence-based Practice in | Pathophysiology | | | | Neonatal Care | applied to | | | | • Advanced Skills in Leadership, | Neonatal Care | | | | Management and Teaching | • Advanced | | | +--------------------------------------------------------------+ Pharmacology | | | | III. | applied to | | | | Specia | Neonatal Care | | | | lty | • Advanced | | | | Course | Health/Physical | | | | s | Assessment in | | | | • Foundations of Neonatal Nursing Practice | Neonatal | | | | • Neonatal Nursing I | Nursing | | | | • Neonatal Nursing II | | | | +--------------------------------------------------------------+-----------------+ | | NP | | | | NEONATAL | II. | | | NURSING | Adv | | | PROGRAM | ance | | | | d | | | | Pract | | | | ice | | | | Cour | | | | ses | | | Practicum - 85% | | +---------------------------+----------------------------------------------------------------+-----------------+ II. Program Description The Nurse Practitioner in Neonatal Nursing (NPNeoN) program is a nursing residency program with a 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). III. Aim The NPNeoN program prepares registered B.Sc. nurses for advanced practice roles as clinical experts, managers, educators and consultants leading to M.Sc. Nursing (Nurse Practitioner in Neonatal Nursing). IV. Objectives On completion of the program, the Neonatal NP will be able to - 1. Assume responsibility and accountability to provide competent care to critically ill neonates and their family in tertiary care NCUs. 2. Demonstrate clinical competence/expertise in providing critical care to neonates which includes diagnostic reasoning, complex monitoring and therapies. 3. Apply theoretical, pathophysiological, and pharmacological principles and evidence base in implementing therapies/interventions to neonates requiring critical care. 4. Identify the critical conditions using differential diagnosis and carry out treatment/interventions to stabilize and restore neonate’s health and minimize or manage complications independently or collaboratively as a part of NCU team. 5. Collaborate with other health care professionals in the NCU team, across the continuum of neonatal care. V. Minimum requirements to start the Nurse Practitioner in Neonatal Nursing (NPNeoN) Program The institution must accept the accountability for the NPNeoN program and its students and offer the program congruent with the Council standards. It must fulfill the following requirements: 1. Essentiality Certificate a. If any institution opting to start NPNeoN program already has B.Sc. Nursing or M.Sc. Nursing program recognized by the Council, it will be exempted from NOC (No Objection Certificate)/Essentiality Certificate for NPNeoN postgraduate residency program from State Government. b. If the institution is having any University education program of training nurses and doctors or if they have DNB program, NOC will not be required to start NP program. 2. Hospital a. The institute should have a parent hospital/tertiary care centre with a minimum of 200 beds. b. It is preferable to have a medical college/nursing college attached to the parent hospital. 3. NCU Beds The hospital should have a minimum of 20 NCU beds namely basic care, advanced care, and specialized care. 4. NCU Staffing a. Every NCU should have a Charge Nurse preferably with B.Sc. Nursing or Post Basic Diploma in Neonatal Nursing or M.Sc. Nursing qualification. b. The nurse neonate ratio should be 1 : 1 for every shift for ventilated neonates. c. For the rest of NCU beds the nurse neonate ratio should be 1 : 2 for every shift. d. Provision of additional 45% staff towards leave reserve. 5. Faculty/Staff Resources a. Clinical Area i. Nursing Preceptor: Full time qualified GNM with 6 years’ experience in Neonatal Nursing or B.Sc. Nursing with 2 years of experience in Neonatal Nursing or Post Basic Diploma in Neonatal Nursing with 2 years of experience in Neonatal Nursing or M.Sc. (Pediatric Nursing/Obstetrics & Gynaecology Nursing) with one-year Neonatal Nursing experience. ii. Medical Preceptor: MD Neonatology/Pediatrics. 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 full time faculty qualified Nurse Practitioner in the Specialty/M.Sc. in Pediatric Nursing/Neonatal Nursing/NPNeoN), (1 faculty for every 10 students). ii. Assistant Professor: 1 (M.Sc. Nursing with teaching experience of 3 years). c. The above faculty shall perform dual role or be a senior nurse with M.Sc. Nursing qualification in Pediatric Nursing employed in the neonatal units of tertiary hospital. d. Guest Lecturers for Pharmacology, Pathophysiology and Neonatology relevant to neonatal care. 6. 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 journals. d. E-learning facilities. 7. List of equipment for NCU (enclosed Appendix 1). 8. Student Recruitment/Admission Requirements a. Applicants must possess a registered B.Sc. Nursing/P.B.B.Sc. Nursing degree with a minimum of one-year clinical experience, preferably in any Neonatal care Units (NCUs) prior to enrollment. b. Must have undergone B.Sc. Nursing in an institution found suitable by the Council and have 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 5 NCU beds. 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 course 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 year’s 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 NPNeoN program/M.Sc. Nursing faculty (with specialty-Pediatric Nursing-NPNeoN preferable) and with 5 years’ post PG experience)}. ii. one external examiner (same as above) iii. one medical internal examiner who should have served as preceptor for NPNeoN program. Dissertation Research Guides: Main guide: Nursing faculty (3 years’ post PG experience) teaching NPNeoN 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 neonatal nursing that will add knowledge or evidence for nursing intervention. The research should be conducted in any of the neonatal 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 and Dissertation report = 50 marks University Examination: Viva and Dissertation report = 50 marks (Marking guide used for other M.Sc. Nursing specialties can be used for evaluation). VII. Assessment (Formative and Summative) • Quiz • Seminar • Written assignments/Term papers • Case/Clinical presentation • Nursing process report/Care study report/Care pathway • Drug studies • Clinical performance evaluation • Log Book (Competency list and clinical requirements) counter signed by the medical/nursing faculty preceptor • Objective Structured Clinical Examination (OSCE)/OSPE • 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 | 2 50 | | | | Nursing | | | | 2 | Research Application and Evidence-based | 3 30 70 | | | | Practice in Neonatal Care | | | | 3 | Advanced Skills in Leadership, Management | 3 30 70 | | | | and Teaching | | | | | Advanced Practice Courses | | | | 4 | Advanced Pathophysiology & Advanced | 3 30 70 | | | | Pharmacology applied to Neonatal Care | | | | 5 | Advanced Health/Physical Assessment in | 3 30 70 | 50 50 | | | Neonatal Nursing | | | +-------+-------------------------------------------------------+-------------------------+-------------------------+ | IInd year | | | +-------+-------------------------------------------------------+-------------------------+-------------------------+ | | Specialty Courses | | | | 1 | Foundations of Neonatal Nursing Practice | 3 30 70 | 100 100 | | 2 | Neonatal Nursing I | 3 30 70 | 100 100 | | 3 | Neonatal Nursing II | 3 30 70 | 100 100 | | 4 | Dissertation and Viva | | 50 50 | +-------+-------------------------------------------------------+-------------------------+-------------------------+ VIII. Courses of Instruction +-------+-------+-------------------------------------------------------+---------------+-----------------+----------------+ | S.No. | Title | Theory | Lab/Skill | Clinical | | | | (hours) | Lab (hours) | (hours) | +-------+-------+-------------------------------------------------------+---------------+-----------------+----------------+ | Ist year | | | | +-------+-------+-------------------------------------------------------+---------------+-----------------+----------------+ | | Core Courses | | | | | I | Theoretical Basis for Advanced Practice Nursing | 40 | | | | II | Research Application and Evidence-based Practice in | 56 | 24 | 336 (7 weeks) | | | Neonatal Care | | | | | III | Advanced Skills in Leadership, Management and | 56 | 24 | 192 (4 weeks) | | | Teaching | | | | | | Advanced Practice Courses | | | | | IV | Advanced Pathophysiology applied to Neonatal Care | 60 | | 336 (7 weeks) | | V | Advanced Pharmacology applied to Neonatal Care | 54 | | 336 (7 weeks) | | VI | Advanced Health/Physical Assessment in Neonatal | 70 | 48 | 576 (12 weeks) | | | Nursing | | | | | | TOTAL = 2208 hours | 336 (7 weeks) | 96 (2 weeks) | 1776 (37 weeks)| +-------+-------+-------------------------------------------------------+---------------+-----------------+----------------+ | IInd year | | | | +-------+-------+-------------------------------------------------------+---------------+-----------------+----------------+ | | Specialty Courses | | | | | VII | Foundations of Neonatal Nursing Practice | 96 | 48 | 576 (12 weeks) | | VIII | Neonatal Nursing I | 96 | 48 | 576 (12 weeks) | | IX | Neonatal Nursing II | 96 | 48 | 624 (13 weeks) | | | 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 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 + Lab = 15%, Clinical = 85%] IInd year: 288-144-1776 hours (Theory-Skill Lab-Clinical) [Theory + Lab = 15%, Clinical = 85%] Ist year = 46 weeks/2208 hours (46×48 hours) (Theory + Lab: 7.5 hours per week for 44 weeks = 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. 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) +-----------------------------------------------+------------+ | Clinical Areas | Weeks | +-----------------------------------------------+------------+ | SNCU | 6 | | NICU Level II | 6 | | NICU Level III | 6 | | Antenatal Clinic | 2 | | Genetic Counselling Clinic | 2 | | Human Milk Banking/Lactational Counselling | 1 | | Newborn Follow-up Clinic | 2 | | Antenatal Ward | 2 | | Postnatal Ward | 2 | | Labour Room including Maternity Emergency and OT| 4 | | Pediatrics OPD | 2 | | Immunization Clinic | 2 | | AAM (Ayushman Aarogya Mandir)/HWC (Health Wellnes|s Center) 2 | | CHC/PHC | 2 | | Neonatal/Pediatrics Emergency | 1 | | Pediatric Surgical Ward | 2 | +-----------------------------------------------+------------+ | TOTAL | 44 weeks | +-----------------------------------------------+------------+ IInd year: 45 weeks (excludes one week of block classes) +-----------------------------------------------+------------+ | Clinical Areas | Weeks | +-----------------------------------------------+------------+ | SNCU | 6 | | NICU Level II | 6 | | NICU Level III | 6 | | Antenatal Clinic | 2 | | Genetic Counselling Clinic | 2 | | Human Milk Banking/Lactational Counselling | 1 | | Newborn Follow-up Clinic | 2 | | Antenatal Ward | 2 | | Postnatal Ward | 2 | | Labour Room including Maternity Emergency and OT| 2 | | Pediatrics OPD | 2 | | Immunization Clinic | 2 | | AAM (Ayushman Aarogya Mandir)/HWC (Health Wellnes|s Center) 2 | | CHC/PHC | 2 | | Neonatal/Pediatrics Emergency | 2 | | Pediatric Surgery ICU/OT | 4 | +-----------------------------------------------+------------+ | TOTAL | 45 weeks | +-----------------------------------------------+------------+ C. Teaching Methods Teaching: Theoretical, Lab and 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 studies, presentation and report • Nursing rounds • Clinical seminars • Journal clubs • Case study/Nursing process/Care pathway • Advanced health assessment • Faculty lecture in the clinical area • Directed reading • Assignments • Case study analysis • Workshops D. Procedures/Log Book At the end of each clinical posting, Clinical Log Book (Specific Procedural Competencies/Clinical Skills) (Appendix 3a and 3b) and Clinical Requirements (Appendix 4) has to be signed by the preceptor/faculty every fortnight. E. Nurse Practitioner in Neonatal Nursing Competencies (Adapted from ICN, 2005) 1. Uses theory, research evidence, observations, and experience in clinical decision-making. 2. Practices in accordance with professional, legal, and ethical responsibilities affecting neonatal practice. 3. Fulfils the conduct requirement for the profession of nursing. 4. Documents assessment, diagnosis, management and monitors treatment and follow-up care of neonates. 5. Administers 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 authorizes and the regulatory framework allows in the interest of the neonates, 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 neonates. 11. Develops a practice that is based on current scientific evidence and incorporated into the health management of neonates, families and communities. 12. Introduces, tests, evaluates and manages evidence-based practice. 13. Practices within agreed parameters, apply knowledge, clinical judgment, and a range of skills to provide safe and effective neonatal care. 14. Maintains ongoing neonatal knowledge. 15. Defines areas of neonatal deficiencies within their scope of practice and find ways to alleviate those deficiencies. 16. Develops and implements a plan of care that is individualized to the neonate/family according to unit policies and guidelines. 17. Ensures that written documentation is clear and follows local guidelines and standards. 18. Demonstrates awareness of current practices available in neonatal nursing. 19. Provides evidence-based neonatal care. 20. Maintains and improves quality in all aspects of neonatal nursing. 21. Uses research to produce evidence-based practice to improve the safety, efficiency and effectiveness of care through independent and inter-professional research. 22. Engages in ethical practice in all aspects of the APN role and responsibility. 23. Accepts accountability and responsibility for own advanced professional judgement, actions, and continued competence. 24. Creates and maintains a safe therapeutic environment using risk management strategies and quality improvement. 25. Assumes leadership and management responsibilities in the delivery of efficient advanced practice nursing services in a changing health care system. 26. Acts as an advocate for neonates in the health care systems and the development of health policies that promote and protect the individual neonate, family, and community. 27. Adapts practice to the contextual and cultural milieu. F. 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 | | | | • Lecture (Faculty) | | | Nursing (40) | | | | | | 2. | Research Application and | 8 hours | 40 (5 days)| 1×24=24 hours | • Research Study Analysis/ | | | Evidence-based Practice | | + 8 hours| | Exercise/Assignment (Lab)| | | in Neonatal Care (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 | | | 1.5×40=60 hours | • Case Presentation | | | Pathophysiology applied | | | | • Seminar | | | to Neonatal Care (60) | | | | • Clinical Conference | | 5. | Advanced Pharmacology | 10 hours | | 1×44=44 hours | • Nursing Rounds | | | applied to Neonatal Care | | | | • Drug Study Presentation | | | (54) | | | | • Standing Orders/ Presentatio| | 6. | Advanced Health/ | 8 hours | | 2×26=52 hours | n | | | Physical Assessment in | | | 1.5×18=27 hours | • Clinical Demonstration (Fac| | | Neonatal Nursing (70+48) | | | 1×15=15 hours | ulty) | | | | | | 2×6=12 hours | • Return Demonstration | | | | | | 2×2=4 hours | • Nursing Rounds | | | | | | | • 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 Neonatal Nursing Practice | 9×16=144 hours | • Demonstration (Lab) | | (96+48=144 hours) | | • Return Demonstration (Lab) | | | | • Clinical Teaching | | | | • Case Study | | | | • Seminar | | | | • Clinical Conference | | | | • Faculty Lecture | | 2. Neonatal Nursing I (96+48=144 hours) | 9×16=144 hours | • Demonstration (Lab) | | | | • Return Demonstration (Lab) | | | | • Clinical Conference/Journal Club | | | | • Seminar | +-----------------------------------------------+-----------------------------+------------------------------------+ +-----------------------------------------------+-----------------------------+------------------------------------+ | IInd year Courses | Theory including Skill Lab | Methods of Teaching | | 1 week Block Classes (48 hours) | integrated into Clinical | | | | Practicum | | +-----------------------------------------------+-----------------------------+------------------------------------+ | 3. Neonatal Nursing II (96+48=144 hours) | 9×16=144 hours | • Demonstration (Lab) | | | | • 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 neonatal care. 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 neonatal 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. 10. Applies the knowledge of nursing theories in providing competent care to critically ill neonates. 11. Predicts future challenges of Nurse Practitioner’s roles in variety of healthcare settings 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 | 2 | | | Health Care Delivery System in India - Changing Scenario (Competency 3)| | | 3. | National Health Planning - 5-Year Plans and National Health Poli|cy (Competency 2) 2 | | 4. | Health Economics and Health Care financing (Competency 4) | 4 | | 5. | Health Information System including Nursing Informatics (Use of C|omputers)| 4 | | | (Competency 5) | | | | Advanced Practice Nursing (APN) | | | 6. | APN - Definition, Scope, Philosophy, Accountability, Roles and R|esponsibilities| 3 | | | (Collaborative Practice and Nurse Prescribing Roles) (Competency| 6 and 7) | | 7. | Regulation (Accreditation of Training Institutions and Credential|ing) and | 3 | | | Ethical Dimensions of Advanced Practice Nursing Role (Competency| 8) | | 8. | Nurse Practitioner - Roles, Types, Competencies, Clinical setti|ngs for Practice,| 3 | | | Cultural Competence (Competency 6) | | | 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 applied to APN (Competency 9) | 2 | +-------+-----------------------------------------------------------------+-------+ +-------+-----------------------------------------------------------------+-------+ | S.No. | Topic | Hours | +-------+-----------------------------------------------------------------+-------+ | | Self-Learning Assignments | 6 | | 1. | Identify Health Care and Education Policies and analyze its impa|ct on Nursing| | | 2. | Describe the legal position in India for Neonatal NP practice. W|hat is the future of nurse| | | | prescribing policies in India with relevance to these policies i|n other countries?| | | 3. | Examine the nursing protocols relevant to Neonatal NP practice f|ound in various NCUs in| | | | tertiary Centre | | +-------+-----------------------------------------------------------------+-------+ | | 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 • Council of International Neonatal Nurses, Inc. Working Group (CoINN-WG) • Specialist nursing panel of the Council of International Neonatal Nurses, Inc. (CoINN). (2019) • DeNisco & Barkers A.M. (2015) Advanced Practice Nursing: Essential Knowledge for the Profession (3rd ed.) Massachusetts: Jones & Bartlett Publishers • 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 • Nand L. & Anilkumar A. (2021) Role of nurse practitioners within health system in India: A case of untapped potential, Journal of family medicine and primary care 10(8) 2751-2756 • Mehrban Singh (2017) Essentials of pediatric nursing (4th ed) CBS Publishers • NONPF (2022) Nurse practitioner role competencies, National Organization of Nurse Practitioner Faculties • Sastre-Fullana P., Gray D.C., Cashin A., Bryant-Lukosius D., Schumann L., Geese F. & Bird B. (2021) Visual analysis of global comparative mapping of the practice domains of the nurse practitioner/advanced practice nursing role in respondent countries, Journal of the American Association of Nurse Practitioners 33(7) 496-505 • 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 Neonatal Care COMPETENCIES 1. Applies sound research knowledge and skills in conducting independent research in Neonatal Nursing. 2. Participates in collaborative research to improve neonatal 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 neonatal nursing practice. 5. Analyzes the evidence of nursing interventions carried out in neonatal 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: Significance of Research| and inquiry related to| 2 | | | neonatal nursing role (Competency 1) | | | 2. | Research agenda for APN practice: Testing current practice to dev|elop best practice, health| 5 | | | outcomes and indicators of quality care in neonatal nursing prac|tice (Competency 3, 4, 5),| | | | promoting research culture | | | 3. | Research Knowledge and Skills: | 40 | | | Research competencies essential for APNs (interpretation and us|e of research, evaluation of| (5 day| | | practice, participation in collaborative research) | s | | | Introduction to Evidence Based Practice (EBP) project - PiCOT q|uestion, steps of planning,| workshop)| | | 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) writi|ng research proposal and| | | | research report (Competency 1 & 2) | | +-------+-----------------------------------------------------------------+-------+ Lab/Skill Lab & Assignments: 24 hours • Identifying research priorities • Writing exercises on Research question, objectives and hypothesis • Writing research proposal/EBP project proposal • Scientific paper writing - preparation of manuscript for publication • Writing systematic review - Analyze the evidence for a given nursing intervention in any NCU setting Clinical Practicum • Research Practicum: Dissertation (336 hours=7 weeks)/Evidence Based Practice Project (EBP project) Bibliography • Gray J. & Grove S.K. (2020) Burns & Groves: The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence (9th ed.) St. Louis: Elsevier Saunders • Mehrban Singh (2017) Essentials of Pediatric Nursing (4th ed.) CBS Publishers • 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 nurse’s appraisal and application of research, Sd: Jones & Bartlet Publishers III. Advanced Skills in Leadership, Management and Teaching COMPETENCIES 1. Applies principles of leadership and management in neonatal care units. 2. Manages stress and conflicts effectively in a Neonatal Nursing 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 neonatal care in NCU. 5. Builds teams and motivates others in neonatal care setting. 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 neonatal care, maintaining quality and ethics in NCU setting. 10. Provides counseling to parents and families of neonates in crisis situations particularly end of life care. 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 neonatal care| settings| 4 | | 4. | Stress management and conflict management - principles and appli|cation to neonatal care| 4 | | | environment, effective time management | | | 5. | Quality improvement and audit | 4 | | 6. | Problem solving, critical thinking and communication skills appli|ed to neonatal critical care nursing| 5 | | | practice | | | 7. | Team building, motivating and mentoring within NCU set up | 2 | | 8. | Budgeting and management of resources including human resources | - NCU budget, material management, staffing, assignments| 5 | +-------+-----------------------------------------------------------------+-------+ +-------+-----------------------------------------------------------------+-------+ | S.No. | Topic | Hours | +-------+-----------------------------------------------------------------+-------+ | 9. | Change and innovation | 2 | | 10. | Staff performance, and evaluation (performance appraisals) | 6 | | 11. | Teaching - Learning theories and principles applied to Neonatal |Nursing| 2 | | 12. | Competency based education and outcome-based education | 2 | | 13. | Teaching methods/strategies, media: educating family and staff i|n neonatal care settings| 8 | | 14. | Staff education and use of tools in evaluation | 4 | | 15. | APN - Roles as a teacher | 2 | | 16. | Advocacy roles in neonatal care environment | 2 | +-------+-----------------------------------------------------------------+-------+ | | Total | 56 hours| +-------+-----------------------------------------------------------------+-------+ Lab/Skill Lab: 24 hours • Preparation of staff neonate 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/parent education sessions • Preparation of teaching method and media for parents of neonates and staff • Planning and conducting OSCE/OSPE • Construction of tests Assignment: NCU work place violence Bibliography • Horntvedt M.T., Nordsteien A., Fermann T. & Severinsson E. (2018) Strategies for teaching evidence-based practice in nursing education: a thematic literature review, BMC medical education 18(1) 172, https://doi.org/10.1186/s12909-018-1278- • Liebler J.G. & McConnell C.R. (2020) Management principles for health professionals, Jones & Bartlett Learning • Mehrban Singh (2017) Essential of pediatric nursing (4th ed.) CBS Publishers • Sastre-Fullana P., Gray D.C., Cashin A., Bryant-Lukosius D., Schumann L., Geese F. & Bird B. (2021). Visual analysis of global comparative mapping of the practice domains of the nurse practitioner/advanced practice nursing role in respondent countries. Journal of the American Association of Nurse Practitioners 33(7) 496-505 • Weiss S.A., Tappen R.M. & Grimley K. (2019) Essentials of nursing leadership & management, FA Davis ADVANCED NURSING COURSES IV. A. Advanced Pathophysiology applied to Neonatal Care I COMPETENCIES 1. Integrates the knowledge of pathophysiological process in critical conditions in developing diagnosis and plan of care. 2. Applies the pathophysiological principles in symptom management and secondary prevention of critical illnesses. 3. Analyzes the pathophysiological changes relevant to each critical illness recognizing the value of diagnosis, treatment, care and prognosis. Hours of Instruction: Theory: 30 hours +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | I | 8 | Respiratory disorders | | | | • Embryogenic foetal development of respiratory system| | | | • Respiratory distress in newborn babies/hyaline memb|rane disease| | | | • Respiratory system disorders | | | | • Meconium aspiration syndrome | | | | • Intrauterine and postnatal pneumonia | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | • Massive pulmonary hemorrhage | | | | • Pneumothorax | | | | • Pleural effusion | | | | • Transient tachypnea of the newborn | | | | • Bronchopulmonary dysplasia | | | | • Respiratory surgical emergencies | | II | 6 | Cardiovascular disorders | | | | • Embryogenic foetal development of cardiovascular sy|stem| | | | • Foetal and neonatal circulation | | | | • Persistent pulmonary hypertension | | | | • Congenital complete heart block | | | | • Supraventricular tachycardia | | | | • Congenital cardiac malformation (VSD, ASD, PDA, AV| canal defect, coarctation of aorta,| | | | Ebstein anomaly, Eisenmenger syndrome, patent foram|en ovale, pulmonary atresia, TOF,| | | | TAPVR, transposition of great arteries, truncus art|eriosus)| | | | • Shock | | III | 4 | Genitourinary disorders | | | | • Embryogenic foetal development of genitourinary sys|tem| | | | • Acute renal failure | | | | • Renal malformation | | | | • Congenital nephrotic syndrome | | | | • Urinary tract infection | | | | • Abdominal masses | | | | • Nephrocalcinosis | | | | • Ambiguous external genital | | | | • Hypospadias and epispadias | | | | • Undescended testis | | IV | 4 | Neurological disorders | | | | • Embryogenic foetal development of neurological sys|tem| | | | • Intracranial haemorrhage | | | | • Intraventricular haemorrhage | | | | • Neurological sequelae of hypoxic-ischemic encephal|opathy periventricular leukomalacia| | | | • Birth trauma to CNS | | | | • CNS malformations | | | | • Jitteriness | | | | • Neonatal seizures | | | | • Floppy neonate | | V | 4 | Gastrointestinal disorders | | | | • Embryogenic foetal development of gastrointestinal| system| | | | • Diarrhoea | | | | • GERD | | | | • TEF (Tracheooesophageal atresia) | | | | • Cleft lip/cleft palate | | | | • Exomphalos (omphalocele) | | | | • Gastroschisis | | | | • Congenital diaphragmatic hernia | | | | • Jaundice | | | | • Biliary atresia | | | | • Hirschsprung disease | | | | • congenital bowel obstruction/perforation | | | | • Hypertrophic pyloric stenosis | | | | • Small bowel atresia | | | | • Intussusception | | | | • Meconium ileus | | | | • Neonatal cholestasis | | | | • Anorectal anomalies | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | • Necrotizing enterocolitis | | VI | 4 | Endocrine disorders | | | | • Embryogenic foetal development of endocrine system| | | | • Transient neonatal hypoglycaemia and hyperglycaemia| | | | • Adrenal gland problems (relative adrenal insufficien|cy, congenital adrenal hyperplasia| | | | • Thyroid problem (transient hypothyroidism and hyper|thyroidism, transient neonatal| | | | hyperthyrotropinemia, hypothyroxinaemia of prematur|ity)| | | | • Genital and urinary problems (hydrocolpos and hydro|metrocolpos ovarian hyperstimulation| | | | syndrome priapism) | | | | • Acne neonatorum | | | | • Transient hypocalcaemia and hypercalcemia | +-------+-------+-------------------------------------------------------+ | Total | 30 hours| | +-------+-------+-------------------------------------------------------+ IV. B. Advanced Pathophysiology applied to Neonatal Care II Hours of Instruction: Theory: 30 hours +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | I | 8 | Hematologic Problems | | | | • Embryogenic fetal development of hematologic system | | | | • Bleeding disorders | | | | o Disorders of red blood cells | | | | ▪ Sickle cell diseases | | | | - Anemia | | | | - Thrombocytopenia | | | | - Hyper-viscosity | | | | o Disorders of white blood cells | | | | ▪ Leucopenia | | | | ▪ Neoplastic disorders | | | | o Disorders of hemostasis | | | | ▪ Platelet disorders | | | | ▪ Coagulation disorders | | | | ▪ Disseminated intravascular coagulation | | | | o Neonatal Hemophilia | | | | • Hemorrhagic disease of the newborn | | | | • Vitamin K prophylaxis | | | | • Disseminated intravascular coagulation | | | | • Polycythemia | | | | • Arterial and venous thromboses | | II | 3 | Metabolic Disorders | | | | • Embryogenic fetal development of metabolic disorde|r| | | | • Phenylketonuria | | | | • Hypoglycemia | | | | • Hyperglycemia | | | | • Hypocalcemia | | | | • Osteopenia of prematurity | | | | • Hypercalcemia | | | | • Hypomagnesemia | | | | • Late metabolic acidosis | | | | • Inborn errors of metabolism (IEM) | | | | • Newborn screening | | | | • Neonatal thyroid screening | | III | 2 | Orthopedic Conditions | | | | • Embryogenic fetal development of orthopedic disord|er| | | | • Talipes equinovarus (club foot) | | | | • Calcaneovalgus deformity | | | | • Genu recurvatum | | | | • Congenital dislocation of hips | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | IV | 4 | Integumentary Function | | | | Advanced pathophysiological process of integumentary c|onditions| | | | • Transient Vascular Phenomena | | | | • Erythema toxicum neonatorum | | | | • Transient Neonatal Pustular Melanosis | | | | • Neonatal Pemphigus | | | | • Collodion Baby | | | | • Umbilical Granulomas | | | | • Diaper Dermatitis | | | | • Miliaria | | | | • Milia | | | | • Neonatal Acne | | | | • Acropustulosis of infancy | | V | 4 | Specific Infections | | | | Advanced pathophysiological process of specific infect|ions| | | | • HIV/AIDS | | | | • Parent to child transmission of HIV and other infec|tion| | | | • TORCH | | | | • Tetanus | | | | • SARS | | | | • Rickettsiosis | | | | • Leptospirosis | | | | • Dengue | | | | • Malaria | | | | • Neonatal sepsis | | | | • Rabies | | | | • Avian flu | | | | • COVID-19 | | VI | 4 | Multi-system Alterations requiring Neonatal Care | | | | • Trauma | | | | • Sepsis | | | | • Shock | | | | • Multiple Organ Dysfunction | | | | • Systemic inflammatory response syndrome | | | | • Anaphylaxis | | | | • Other injuries (Heat, Electrical, Near hanging, Nea|r drowning)| | | | • Envenomation | | | | • Drug overdose | | | | • Poisoning | | VII | 5 | Miscellaneous Conditions | | | | • Embryogenic fetal development of miscellaneous diso|rders| | | | • Birth injuries | | | | • Cyanosis | | | | • Indications for oxygen therapy | | | | • Retinopathy of prematurity | | | | • Edema and hydrops fetalis | | | | • Ascites | | | | • Sclerema | | | | • Vesiculobullous skin eruptions | | | | • Neonatal erythroderma | | | | • Ichthyosis | | | | • Vascular nevi | | | | • Disorders of pigmentation | | | | • Multiple pregnancy | | | | • Iatrogenic disorders | +-------+-------+-------------------------------------------------------+ | Total | 30 hours| | +-------+-------+-------------------------------------------------------+ Bibliography • Kenner C., Leslie Altimier D.N.P. & Boykova M.V. (Eds.) (2019) Comprehensive neonatal nursing care, Springer Publishing Company • Kutlubay Z., Tanakol A., Engýn B., Onel C., Sýmsek E., Serdaroglu S., Tuzun Y., Yilmaz E. & Eren B. Newborn Skin: Common Skin Problems, Maedica (Bucur) 2017 Jan. 12(1): 42-47, PMID: 28878836; PMCID: PMC5574071 • Kurtoğlu S., Direk G., Tatlı Z.U. & Hatipoğlu N. (2019) Transient endocrinologic problems in the newborn period, Turk pediatriarsivi 54(1) 3-12, https://doi.org/10.14744/TurkPediatriArs.2019.04810 • Lee Y., Lim Y.S., Lee S.T. & Cho H. (2018) Pediatric renovascular hypertension: Treatment outcome according to underlying disease, Pediatrics International 60(3) 264-269 • Mehrban Singh (2017) Essentials of pediatric nursing (4th ed.) CBS Publishers • Norris T.L. & Lalchandani R. (2018) Porth’s pathophysiology: concepts of altered health states. Lippincott Williams & Wilkins • Urden L.D., Stacy K.M. & Lough M.E. (2014) Neonatal Nursing: Diagnosis and management (7th ed.) Elsevier: Missouri V. Advanced Pharmacology applied to Neonatal Care COMPETENCIES 1. Applies the pharmacological principles in providing care to critically ill neonates and families. 2. Analyzes pharmaco-therapeutics and pharmacodynamics relevant to drugs used in the treatment of neonatal conditions. 3. Performs safe drug administration based on principles and institutional protocols. 4. Documents accurately and provides follow up care. 5. Applies sound knowledge of drug interactions in administration of drugs to critically ill neonates in the neonatal 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 Neonatology | | | | • History | | | | • Classification of drugs and schedules | | II | 4 | Pharmacokinetics and Pharmacodynamics | | | | • Introduction | | | | • Absorption, distribution, metabolism and excretion |in neonatal care| | | | • 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 | | | | ▪ Enteral drug administration | | | | ▪ Topical drug administration | | | | ▪ Parenteral drug administration | | III | 5 | Pharmacology and Cardiovascular Alterations in Neona|tology| | | | • Vasoactive Medications | | | | ▪ Vasodilator | | | | ▪ Vasopressor | | | | ▪ Inotropes | | | | - Cardiac glycosides - digoxin | | | | - Sympathomimetics - dopamine, dobutamine, epineph|rine, isoproterenol,| | | | norepinephrine, phenylephrine | | | | - Phosphodiesterase inhibitors - amrinone, milrinone| | | | • Antiarrhythmic Medications | | | | • Cardiac neonatal care conditions | | | | ▪ Medications to improve cardiac contractility | | | | ▪ Medications in the management of hypertension in n|eonatal care| | | | ▪ Medications in the management of heart failure | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | ▪ Medications in the management of angina pectoris an|d myocardial infarction| | | | ▪ Medications in the management of dysrhythmias, hea|rt block and conduction| | | | disturbances | | | | ▪ Medications in the management of pulmonary hyperten|sion, congenital malformations,| | | | cardiomyopathy | | | | • Institutional Protocols/Standing orders for cardiac| neonatal care emergencies| | IV | 4 | Pharmacology and Pulmonary Alterations in Neonatology| | | | • Mechanical Ventilation | | | | ▪ Introduction | | | | ▪ Medications used on neonates with mechanical ventil|ator| | | | ▪ Mechanical ventilation impact on pharmacotherapy -| sedation and analgesia,| | | | Neuromuscular blockage, nutrition | | | | • Pulmonary neonatal care conditions | | | | • Medications in the management of status asthma | | | | • Medications in the management of pulmonary edema | | | | • Medications in the management of acute respiratory |failure and acute respiratory distress| | | | syndrome | | | | • Medications in the management of chest trauma | | | | • Medications in the management of respiratory distre|ss syndrome| | | | • Medications in the management of Pneumonia | | | | • Medications in the management of Pleural effusion | | | | • Medications in the management of Atelectasis | | | | • Standing orders for pulmonary neonatal care emergen|cies| | V | 6 | Pharmacology and Neurological Alterations in Neonatol|ogy| | | | • Pain | | | | ▪ NSAID | | | | ▪ Opioid analgesia | | | | • Sedation | | | | ▪ Gamma amino butyric acid stimulants | | | | ▪ Fentanyl | | | | ▪ Analgosedation | | | | • 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 insomn|ia| | | | ▪ Antidepressants | | | | ▪ Benzodiazepines | | | | ▪ Barbiturates | | | | • Standing orders for neurology neonatal care emergen|cies| | VI | 5 | Pharmacology and Nephrology Alterations in Neonatol|ogy| | | | • Diuretics | | | | • Fluid replacement | | | | ▪ Crystalloids | | | | ▪ Colloids | | | | • Electrolytes | | | | ▪ Sodium | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | ▪ Potassium | | | | ▪ Calcium | | | | ▪ Magnesium | | | | ▪ Phosphorus | | | | • Nephrology neonatal care conditions | | | | ▪ Medications in the management of acute/chronic rena|l failure| | | | ▪ Medications in the management UTI | | | | ▪ Medications in the management of congenital nephro|tic syndrome| | | | ▪ Medications in the management of electrolyte imbala|nces| | | | ▪ Medications in the management of acid base imbalanc|es| | | | ▪ Medications used during dialysis | | | | • Standing orders for nephrology neonatal care emergen|cies| | VII | 5 | Pharmacology and Gastrointestinal Alterations in Neona|tology| | | | • Antiemetics | | | | • Pancreatic enzymes | | | | • Nutritional supplements, vitamins and minerals | | | | • Gastro intestinal neonatal care conditions | | | | ▪ Medications in the management of GERD | | | | ▪ Medications in the management of diarrheal | | | | ▪ Medications in the management of neonatal cholestas|is| | | | ▪ Medications in the management of congenital bowel |obstruction/perforation| | | | ▪ Medications used during gastrointestinal surgeries| | | | • Standing orders for gastrointestinal neonatal care |emergencies| | VIII | 4 | Pharmacology and Endocrine Alterations in Neonatology| | | | • Insulin and other hypoglycemic agents | | | | • Endocrine neonatal care conditions | | | | ▪ Medications in the management of relative adrenal |insufficiency| | | | ▪ Medications in the management of hypoglycemia | | | | ▪ Medications in the management of transient neonata|l hyperthyrotropinemia| | | | ▪ Medications in the management of hypothyroxinemia |of prematurity| | | | ▪ Medications in the management of transient hypocal|cemia| | | | • Standing orders for endocrine neonatal care emergen|cies| | IX | 5 | Pharmacology and Hematology Alterations in Neonatology| | | | • Anticoagulants | | | | • Antiplatelet drugs | | | | • Thrombolytics | | | | • Hemostatic/antifibrinolytics | | | | • Hematopoietic growth factors | | | | ▪ Erythropoietin | | | | ▪ Colony stimulating factors | | | | ▪ Platelet enhancers | | | | • Blood and blood products | | | | • Whole blood, packed red blood cells, leukocyte-redu|ced red cells, washed red blood cells,| | | | Fresh frozen plasma, cryoprecipitate | | | | ▪ Albumin | | | | ▪ Transfusion reactions, transfusion administration |process| | | | • Vaccines | | | | • Immunostimulants | | | | • Immunosuppressant | | | | • Chemotherapeutic drugs - alkylating agents, anti-me|tabolites, anti-tumor antibiotics,| | | | alkaloids, hormones and hormone antagonist, cortico|steroids, gonadal hormones, anti- estrogens, androgen antagonists, biologic response modifiers| | | | • Hematology neonatal care conditions | | | | ▪ Medications in the management of anemia in critic|al illness| | | | ▪ Medications in the management of DIC | | | | ▪ Medications in the management of thrombocytopen|ia and acute leukemia| | | | ▪ Medications in the management of heparin induced t|hrombocytopenia| | | | ▪ Medications in the management of sickle cell anemi|a| +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | • Standing orders for hematology neonatal care emergen|cies| | X | 3 | Pharmacology and Skin Alterations in Neonatology | | | | • Hematology neonatal care conditions | | | | ▪ Medications used in management | | | | • Medications used in Transient Vascular Phenomena | | | | ▪ Medications used in Erythema Toxicum Neonatorum | | | | ▪ Medications used in Transient Neonatal Pustular Mel|anosis| | | | ▪ Medications used in Neonatal Pemphigus | | | | ▪ Medications used in Umbilical Granulomas | | | | ▪ Medications used in Diaper Dermatitis | | | | • Standing orders for skin neonatal care emergencies| | XI | 5 | Pharmacology and Multisystem Alterations in Neonatol|ogy| | | | • Medications in the management of shock, sepsis, mult|iple organ dysfunction, systemic| | | | inflammatory response syndrome, anaphylaxis | | | | • Medications in the management of trauma, injuries (H|eat, electrical, near hanging, near| | | | drowning) | | | | • Medications in the management of bites, drug overd|ose and poisoning| | | | • Medications in the management of fever in Neonatal |Care Nursing| | | | ▪ Antipyretics | | | | ▪ NSAIDS | | | | ▪ Corticosteroids | | | | • Standing orders for multisystem neonatal care emergen|cies| | XII | 5 | Pharmacology and Infections in Neonatology | | | | • Anti-bacterial drugs | | | | ▪ Introduction | | | | ▪ Beta lactams - penicillin, cephalosporins, monobac|tams, carbapenems| | | | ▪ Aminoglycosides | | | | ▪ Anti-MRSA | | | | ▪ Macrolides | | | | ▪ Quinolones | | | | ▪ Miscellaneous - lincosamide group, nitroimidazole,| tetracycline and chloramphenicol,| | | | polymyxins, antimalarials, antifungals, antivirals | | | | • Anti-fungal drugs | | | | • Anti-protozoal drugs | | | | • Anti-viral drugs | | | | • Choice of antimicrobials | | | | • Infectious neonatal care conditions | | | | ▪ Medications in the management of HIV, Tetanus, SAR|S, Rickettsiosis, Leptospirosis,| | | | Dengue, Malaria, Chikungunya, Rabies, Avian flu and| Swine flu| | | | • Standing Orders for infectious neonatal care emergen|cies| | XIII | 1 | Miscellaneous | +-------+-------+-------------------------------------------------------+ | Total | 54 hours| | +-------+-------+-------------------------------------------------------+ Bibliography • Kanish R., Gupta K., Juneja S., Bains H.S. & Kaushal S. (2014) Prescribing pattern of antibiotics in the department of pediatrics in a tertiary care medical college hospital in Northern India, Asian J Med Sci 5(4) 69-72 • Mehrban Singh (2017) Essentials of pediatric nursing (4th ed.) CBS Publishers • Tayal H., Roy V., Singhal S. & Dubey A.P. (2020) Pediatric prescribing in tertiary care teaching hospital of Delhi (India): fragmenting medicines for use, European Journal of Pediatrics, 179, 1435-1443 • Uma L.W., Isah A., Musa S. & Umar B. (2020) Outpatient prescribing and antibiotic use for children in a tertiary hospital, Sahel Medical Journal 23(2) 109 VI. Advanced Health/Physical Assessment in Neonatal Nursing COMPETENCIES 1. Applies the physical assessment principles in developing appropriate system wise examination skills. 2. Uses health assessment skills to differentiate between variations of normal and abnormal findings. 3. Orders screening and diagnostic tests based on the examination findings. 4. Analyzes the results of various investigations and works collaboratively for development of diagnoses. 5. Documents assessment, diagnosis, and management and monitors follow up care in partnership with health care team members, neonates, and families. Hours of Instruction: Theory: 70 hours + Lab/Skill Lab: 48 hours = 118 hours +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | I | 4 | Introduction | | | | • History taking | | | | Review of this pregnancy, labour, and delivery, incl|uding prenatal screening tests and risk| | | | factors for sepsis | | | | • Review of past pregnancies, including a history of |congenital anomalies, still births, and/or| | | | genetic or syndromic conditions | | | | • Physical examination | | | | Appropriate of Gestational Age (AGA) | | | | SGA, LGA | | | | - New Ballard Scoring | | | | - Dubowitz Scoring | | II | 6 | General Measurements | | | | • Head circumference | | | | • Crown-to-rump length | | | | • Head-to-heel length | | | | • Birth weight | | | | Vital Signs | | | | • Temperature, axillary (97.7°-98°) | | | | • Heart rate | | | | • Respiratory rate | | | | • Blood pressure | | | | General Appearance | | | | • Posture - flexion of head and extremities, which r|est on chest and abdomen| | III | 4 | Skin | | | | • At birth, bright red, puffy, smooth | | | | • 2nd-3rd day, pink, flaky, dry | | | | • Vernix caseosa | | | | • Lanugo | | | | • Edema around eyes, face, legs, dorsa of hands, feet|, and scrotum or labia| | | | • Acrocyanosis | | | | • Cutis marmorata | | | | • Ecchymoses or petechiae | | | | • Milia | | | | • Miliaria or sudamina | | | | • Erythema toxicum | | | | • Mongolian spots | | | | • Nevus simplex (stork bite or salmon patch) | | IV | 2 | Head | | | | • Anterior fontanel - diamond shaped | | | | • Posterior fontanel - triangular | | V | 4 | Eyes | | | | • Lids usually oedematous | | | | • Colour - slate grey, dark blue, brown | | | | • Absence of tears | | | | • Red reflex | | | | • Corneal reflex in response to touch | | | | • Pupillary reflex in response to light | | | | • Blink reflex in response to light or touch | | | | • Rudimentary fixation on objects and ability to fol|low to midline/cross the midline| | VI | 2 | Ears | | | | • Position - top of pinna on horizontal line with out|er canthus of eye| +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | • Startle (Moro) reflex elicited by loud, sudden nois|e or stimulus| | | | • Pinna flexible, cartilage present | | VII | 6 | Mouth and Throat | | | | • Intact, high-arched palate | | | | • Uvula in midline | | | | • Frenulum of tongue | | | | • Frenulum of upper lip | | | | • Sucking reflex - strong and coordinated | | | | • Rooting reflex | | | | • Gag reflex | | | | • Extrusion reflex | | | | • Absent or minimum salivation | | | | • Vigorous cry | | | | • Natal teeth | | VIII | 2 | Neck | | | | • Short, thick, usually surrounded by skinfolds | | | | • Tonic neck reflex | | | | • Torticollis (wry neck) - head held to one side with| chin pointing to opposite side| | | | Nose | | | | • Nasal patency | | | | • Nasal discharge - thin white mucus | | | | • Sneezing | | IX | 4 | Chest | | | | • Anteroposterior and lateral diameters equal | | | | • Slight sternal retractions evident during inspirati|on| | | | • Xiphoid process evident | | | | • Breast enlargement | | | | • Funnel chest (pectus excavatum) | | | | • Pigeon chest (pectus carinatum) | | | | • Supernumerary nipples | | | | • Secretion of milky substance from breasts (“witch’s| milk”)| | X | 2 | Lungs | | | | • Respirations chiefly abdominal | | | | • Cough reflex absent at birth, present by 1-2 days | | | | • Bilateral equal bronchial breath sounds | | XI | 2 | Heart | | | | • Apex - 4th-5th intercostal space, lateral to left st|ernal border| | | | • S2 slightly sharper and higher in pitch than S1 | | XII | 6 | Abdomen | | | | • Cylindric in shape | | | | • Liver - palpable 2-3 cm (0.8-1.8 inches) | | | | • Below right costal margin | | | | • Spleen - tip palpable at end of 1st week of age | | | | • Kidneys - palpable 1-2 cm (0.4-0.8 inches) above u|mbilicus| | | | • Umbilical cord - bluish white at birth with 2 arter|ies and 1 vein| | | | • Femoral pulses - equal bilateral | | XIII | 2 | Female Genitalia | | | | • Labia and clitoris usually oedematous | | | | • Urethral meatus behind clitoris | | | | • Vernix caseosa between labia | | | | • Urination within 24 hours | | | | • Pseudo menstruation - Blood-tinged or mucoid discha|rge| | | | • Hymenal tag | | XIV | 4 | Male Genitalia | | | | • Urethral opening at tip of glans penis | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | • Testes palpable in each scrotum | | | | • Scrotum usually large, oedematous, pendulous, and c|overed with rugae; usually deeply| | | | pigmented in dark-skinned ethnic groups | | | | • Smegma | | | | • Urination within 24 hours | | | | • Urethral opening covered by prepuce | | | | • Inability to retract foreskin | | | | • Epithelial pearls - small, firm, white lesions at t|ip of prepuce| | | | • Erection or priapism | | | | • Testes palpable in inguinal canal | | | | • Scrotum | | XV | 4 | Back and Rectum | | | | • Spine intact; no openings, masses, or prominent cur|ves| | | | • Trunk incurvation reflex | | | | • Anal reflex | | | | • Patent anal opening | | | | • Passage of meconium within 48 hours | | XVI | 4 | Extremities | | | | • 10 fingers and toes | | | | • Full range of motion | | | | • Nail beds pink, with transient cyanosis immediately| after birth| | | | • Skin creases on anterior 2/3rd of sole | | | | • Sole usually flat | | | | • Symmetry of extremities | | | | • Equal muscle tone bilaterally, especially resistan|ce to opposing flexion| | | | • Equal bilateral brachial pulses | | XVII | 4 | Neuromuscular System | | | | • Extremities usually in some degree of flexion | | | | • Extension of extremity followed by previous positi|on of flexion| | | | • Head lag while sitting, but momentary ability to h|old head erect| | | | • Ability to turn head from side to side when prone | | | | • Ability to hold head in horizontal line with back wh|en held prone| | XVIII | 8 | Newborn Reflexes | | | | • Sucking reflex | | | | • Rooting reflex | | | | • Moro reflex | | | | • Walking/stepping reflex | | | | • Asymmetrical tonic neck reflex (ATNR) | | | | • Symmetrical tonic neck reflex | | | | • Tonic labyrinthine reflex | | | | • Palmar grasp reflex | | | | • Plantar reflex | | | | • Swimming reflex | | | | • Babkin reflex | | | | • Parachute reflex | +-------+-------+-------------------------------------------------------+ | 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 • Newborn examination (system wise) • Monitoring clinical parameters (system wise) Umbilical cannulation/catheterization NIBP, PICC lines, INO therapy, 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), Pediatrics Glasgow coma scale (PGCS), 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), ECMO facilities • Ordering and interpretation of screening and diagnostic tests (system wise) (Enclosed Appendix 3) • Assessment of neonate milestones • Assessment of pregnant women Bibliography • Ball J.W., Dains J.E., Flynn J.A., Solomon B.S. & Stewart R.W. (2021) Seidel’s Guide to Physical Examination - E-Book: An Interprofessional Approach, Elsevier Health Sciences • Bickley L.S. & Szilagyi P.G. (2013) Bate’s guide to physical examination and history taking (11th ed.) New Delhi: Lippincott Williams & Wilkins • Duderstadt K.G. (2017) Pediatric Physical Examination - E-Book: An Illustrated Handbook, Elsevier Health Sciences • Petersen S.W. (2016) Advanced health assessment and diagnostic reasoning, Jones & Bartlett Learning NEONATAL NURSING SPECIALTY COURSES (Foundations of Neonatal Nursing Practice, Neonatal Nursing I and Neonatal Nursing II) COMPETENCIES 1. Applies advanced concepts of Neonatal 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 healthcare team members. 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 neonatal care. 9. Practices independently within the legal framework of the country towards the interest of neonates, 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 Neonatal Nursing Practice Hours of Instruction: Theory: 96 hours + Lab/Skill Lab: 48 hours = 144 hours +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | I | 10 | Introduction to Neonatal Nursing | | | | • Introduction to the course | | | | • Review of anatomy and physiology of vital organs | | | | • Embryological and fetal development, prenatal facto|rs influencing growth and development| | | | of fetus | | | | • Genetic patterns of common pediatric disorders, chr|omosomal aberrations, genetic| | | | assessment and counseling, legal and ethical aspects| of genetic, karyotyping, screening and| | | | counseling, role of nurse in genetic counseling | | | | • Gestational diabetes, effect of maternal medicine o|n fetus and newborn| | | | • Legal and ethical issues in neonatal care - Nurse’s| role| | | | • Current principles, practices and trends in neonata|l nursing| | | | • Role of neonatal nurse in various settings - expand|ed and extended roles| | | | • Concept, aims and scope of preventive neonatology | | | | • Maternal health and its influence on fetal developm|ent, health and antenatal aspects of| | | | preventive neonatology | | | | • Neonatal care unit set up (including levels of NICU,| equipment, supplies, beds and| | | | accessories, use and care of various type of monitor|s & ventilators, flow sheets, supply| | | | lines and the environment) | | | | • Personnel in NCU | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | ▪ Nursing staff | | | | ▪ Doctors | | | | ▪ Neonatal care technicians | | | | ▪ Ancillary staff | | | | • Technology in neonatal care | | | | • Healthy work environment | | | | • Future challenges in Neonatal Nursing | | II | 5 | Concept of Holistic Care applied to Neonatal Nursing |Practice| | | | • Application of nursing process in the care of criti|cally ill| | | | • Admission and progress in NCU - an overall view | | | | • Overview of NCU management | | | | ▪ Ensure adequate tissue oxygenation | | | | ▪ Maintain chemical environment | | | | ▪ Maintain temperature | | | | ▪ Organ protection | | | | ▪ Nutritional support | | | | ▪ Infection control | | | | ▪ Family visiting hours | | | | • Restraints in neonatal care | | | | • Death in neonatal care unit: end of life care/care |of dying, care of family, organ donation| | | | • Transport of the critically ill by air ambulance an|d surface ambulance| | | | • Stress and burnout syndrome among health team membe|rs| | III | 10 | Appraisal of the Critically Ill | | | | Triaging concept, process and principles assessment o|f the critically ill| | | | • General assessment | | | | • Developmental milestones | | | | • Newborn reflexes | | | | • Respiratory assessment | | | | • Cardiac assessment | | | | • Renal assessment | | | | • Neurological assessment | | | | • Gastrointestinal assessment | | | | • Endocrine assessment | | | | • Musculoskeletal assessment | | | | • Integumentary assessment | | | | Monitoring of the critically ill | | | | • Arterial Blood Gas (ABG) | | | | • Capnography | | | | • APGAR Score | | | | • New Ballard Score | | | | • Pediatrics Glasgow Coma Scale (PGCS) | | | | • Premature Infant Pain Profile (PIPP) | | | | • Neonatal Pain Agitation and Sedation Scale (N-PASS)| | | | • Neonatal Infant Pain Scale (NIPS) | | | | • CRIES scale (Crying, Requires Oxygen Saturation, I|ncreased Vital Signs, Expression,| | | | Sleeplessness) FLACC Scale, Silverman Andersen Respi|ratory Severity Score| | | | Evaluation of the critically ill | | | | • Evaluation of pre critical illness | | | | • Evaluation of critical illness | | | | • Outcome and scoring systems | | | | ▪ CRIB (Clinical Risk Index of Babies) | | | | ▪ CRIB-II (Clinical Risk Index of Babies-II) | | | | ▪ SNAP (Score for Neonatal Acute Physiology) | | | | ▪ SNAP-II (Score for Neonatal Acute Physiology-II) | | | | ▪ SNAPPE (Score for Neonatal Acute Physiology - Peri|natal Extension)| | | | ▪ SNAPPE-II | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | IV | 14 | Advanced Concepts and Principles of Neonatal Care | | | | • Principles of cardio-pulmonary-brain resuscitation| | | | • Emergencies in neonatal care: NRP (Neonatal Resusc|itation Program) and NALS| | | | (Neonatal advanced life support) | | | | • Airway management | | | | • Oxygenation and oximetry, care of neonate with oxy|gen delivery devices| | | | • Ventilation and ventilator support (including humi|dification and inhaled drug therapy), care| | | | of neonate with invasive and non-invasive ventilatio|n| | | | • Circulation and perfusion (including hemodynamic ev|aluation and wave form graphics)| | | | • Fluids and electrolytes (review), care of neonate w|ith imbalances of fluid and electrolytes| | | | • Evaluation of acid base status | | | | • Thermoregulation, care of neonate with hyper/hypot|hermia| | | | • Liberation from life support (weaning) | | | | • Glycemic control, care of neonates with glycemic im|balances| | V | 8 | Pain and Management | | | | • Pain in critically ill neonates | | | | • Pain - types, theories | | | | • Physiology, systemic responses to pain and psychol|ogy of pain review| | | | • Acute pain services | | | | • Pain assessment - pain scales, behavior | | | | • Pain management - pharmacological (opioids morphine|, fentanyl, others such as| | | | acetaminophen) | | | | • Nonpharmacological management approaches include ka|ngaroo care, facilitated tucking,| | | | non-nutritive sucking, sucrose and other sweeteners,| massage and acupuncture therapy| | VI | 8 | IMNCI (Integrated Management of Neonatal and Childhoo|d Illness) up to 2 months| | | | • Assess, classify and identify treatment | | | | • Treat the Young Infant and counsel the mother | | | | • Give follow-up care for the Sick Young Infant | | | | • Immunization schedule for young infant, and neonat|es| | | | • Family education and counselling | | VII | 4 | Growth and Development of Neonates | | | | • Principles of growth and development | | | | • Concepts and theories of growth and development, | | | | • Developmental tasks and special needs from infanc|y, developmental delay| | | | • Assessment of growth and development of neonates | | | | • Factors affecting growth and development | | VIII | 5 | Nutrition Alterations and Management in Neonatal Care | | | | • Nutrient metabolism and alterations | | | | • Assessing nutritional status of neonates | | | | • Nutrition and nutritional requirements of neonates| | | | • Changing patterns of feeding | | | | • Baby- friendly hospital initiative and exclusive b|reast feeding| | | | • Health education, nutritional education for adoles|cents| | | | • Nutritional programs | | | | • National and international organizations related t|o neonate’s health| | | | • Care of neonates on enteral and parenteral nutriti|on| | IX | 4 | Sleep Alterations and Management | | | | • Development of sleep in neonates | | | | • Alteration of sleep in NCU | | | | • Bedside tools to monitor sleep | | | | • Neonatal Abstinence Syndrome (NAS) | | X | 5 | Infection Control in Neonatal Care | | | | • Nosocomial infection in neonatal intensive care uni|t; methyl resistant staphylococcus| | | | aureus (MRSA) and other recently identified strains | | | | • Disinfection, Sterilization | | | | • Standard safety measures | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | • Prophylaxis for staff | | | | • Antimicrobial therapy-review | | | | • Families and visitor policies | | XI | 6 | High Risk Newborn | | | | • Concept, goals, assessment, principles | | | | • Nursing management of pre-term, small for gestatio|nal age, post-mature infant, and baby of| | | | diabetic and substance use mothers | | | | • Respiratory conditions, asphyxia neonatorum, neonat|al apnea meconium aspiration| | | | syndrome, pneumothorax, pneumomediastinum | | | | • Icterus neonatorum | | | | • Birth injuries | | | | • Hypoxic ischemic encephalopathy | | | | • Congenital anomalies | | | | • Neonatal seizures | | | | • Neonatal hypocalcemia, hypoglycemia, hypomagnesaem|ia| | | | • Neonatal heart diseases | | | | • Neonatal hemolytic diseases | | | | • Neonatal infections, neonatal sepsis, ophthalmia n|eonatorum, congenital syphilis,| | | | HIV/AIDS | | | | • Advanced neonatal procedures | | | | • Calculation of fluid requirements | | | | • Hematological conditions - erythroblastosis fetalis|, hemorrhagic disorder in the newborn| | XII | 8 | Quality Assurance | | | | • Design of NCU | | | | • Quality assurance models applicable to NCUs | | | | • Standards, protocols, policies, procedures | | | | • Infection control policies and protocols | | | | • Standard safety measures | | | | • Nursing audit relevant to neonatal care | | | | • Staff orientation, training and development | | | | • In-service education program | | | | • Clinical teaching programs | | XIII | 4 | Evidence-based Practice in Neonatal Nursing | | | | • Evidence based practice in neonatal 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) • NRP (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 neonate 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 Noninvasive ventilation ▪ Low flow variable performance devices: nasal catheters/cannula/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 • Inhalation therapy • Circulation and perfusion (including hemodynamic evaluation and wave form graphics) o Invasive blood pressure monitoring o Non-invasive blood pressure monitoring o Venous pressure (peripheral, central and pulmonary artery occlusion pressure) 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 ▪ Phosphodiesterase inhibitors - o Electrolyte correction (Sodium, potassium, calcium, phosphorous, magnesium) o Use of fluid dispenser and infusion pumps • Evaluation of acid base status o Arterial blood gas (ABG) • Thermoregulation, care of neonate with hyper/hypothermia o Temperature probes o Neonatal care management of hyper and hypothermia • Glycemic control, care of neonate 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 • Counseling • Family education VIII. Neonatal Nursing I Hours of Instruction: Theory: 96 hours + Lab/Skill Lab: 48 hours = 144 hours +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | I | 6 | Introduction | | | | • Review of anatomy and physiology of vital organs | | | | • Review of assessment and monitoring of the criticall|y ill| | II | 16 | Cardiovascular Alterations | | | | • Review of clinical assessment, pathophysiology and |pharmacology| | | | • Special diagnostic studies | | | | • Cardiovascular conditions requiring neonatal care ma|nagement| | | | • Fetal and neonatal circulation | | | | • Persistent pulmonary hypertension | | | | • Patent ductus arteriosus | | | | • Congenital complete heart block | | | | • Supraventricular tachycardia | | | | • Congenital cardiac malformation | | | | • Shock | | III | 15 | Pulmonary Alterations | | | | • Review of clinical assessment, pathophysiology and |pharmacology| | | | • Special diagnostic studies | | | | • Pulmonary conditions requiring neonatal care manage|ment| | | | • Respiratory distress in newborn babies | | | | • Respiratory system disorders | | | | • Meconium aspiration syndrome | | | | • Intrauterine and postnatal pneumonia | | | | • Hyaline membrane disease | | | | • Massive pulmonary hemorrhage | | | | • Pneumothorax | | | | • Transient tachypnea of the newborn | | | | • Bronchopulmonary dysplasia | | | | • Pleural effusion | | IV | 15 | Neurological Alterations | | | | • Review of clinical assessment, pathophysiology and |pharmacology| | | | • Special diagnostic studies | | | | • Neurological conditions requiring neonatal care mana|gement| | | | • Intracranial hemorrhage | | | | • Intraventricular hemorrhage | | | | • Neurological sequelae of hypoxic-ischemic encephal|opathy| | | | • Periventricular leukomalacia | | | | • Birth trauma to CNS | | | | • CNS malformations | | | | • Jitteriness | | | | • Neonatal seizures | | | | • Floppy neonate | | V | 15 | Nephrology Alterations | | | | • Review of clinical assessment, pathophysiology and |pharmacology| | | | • Special diagnostic studies | | | | • Nephrology conditions requiring neonatal care manag|ement| | | | • Acute renal failure | | | | • Renal malformation | | | | • Congenital nephrotic syndrome | | | | • Urinary tract infection | | | | • Abdominal masses | | | | • Urinary tract infection | | | | • Nephrocalcinosis | | | | • Recent advances and development | | VI | 12 | Gastrointestinal Alterations | | | | • Review of clinical assessment, pathophysiology and |pharmacology| | | | • Special diagnostic studies | | | | • Gastrointestinal conditions requiring neonatal care| management| | | | • Diarrhea | | | | • GERD | | | | • TEF (Tracheoesophageal atresia) | | | | • Congenital diaphragmatic hernia | | | | • Jaundice | | | | • Congenital bowel obstruction/perforation | | | | • Hypertrophic pyloric stenosis | | | | • Small bowel atresia | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | • Intussusception | | | | • Meconium ileus | | | | • Neonatal cholestasis | | | | • Anorectal anomalies | | | | • Necrotizing enterocolitis | | VII | 12 | Endocrine Alterations | | | | • Review of clinical assessment, pathophysiology and |pharmacology| | | | • Special diagnostic studies | | | | • Endocrine conditions requiring neonatal care manage|ment| | | | • Transient neonatal hypoglycemia and hyperglycemia | | | | • Adrenal gland problems (relative adrenal insufficien|cy, congenital adrenal hyperplasia| | | | • Thyroid problem (transient hypothyroidism and hyper|thyroidism, transient neonatal| | | | hyperthyrotropinemia, hypothyroxinemia of prematuri|ty| | | | • Genital and urinary problems (hydrocolpos and hydro|metrocolpos ovarian hyperstimulation| | | | syndrome priapism | | | | • Acne neonatorum | | | | • Transient hypocalcemia and hypercalcemia | | | | • Recent advances and development | +-------+-------+-------------------------------------------------------+ | | 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). • Cardiovascular Alterations o Thrombolytic therapy o Use of equipment and their settings - Defibrillator, PiCCO, Pacemakers, Intra-Aortic ballon pump (IABP) • Pulmonary Alterations o Tracheostomy care o Nebulization o Chest physiotherapy o Chest tube insertion o Chest drainage • Neurological Alterations o Monitoring PGCS o Conscious and coma monitoring o Monitoring ICP o Sedation score o Brain Death Evaluation • Nephrology Alterations o Dialysis ▪ Priming of dialysis machine ▪ Preparing neonate for dialysis ▪ Cannulating for dialysis ▪ Starting and closing dialysis • Gastrointestinal Alterations o Abdominal pressure monitoring o Calculation of calorie and protein requirements o Special diets - sepsis, respiratory failure, renal failure, hepatic failure, cardiac failure, weaning, pancreatitis o Enteral feeding - NG/Gastrostomy/Pharyngeal/Jejunostomy feeds o Total parenteral nutrition • Endocrine Alterations o Collection of blood samples for cortisol levels, sugar levels, and thyroid hormone levels o Calculation and administration of corticosteroids o Calculation and administration of Insulin - Review IX. Neonatal Nursing II Hours of Instruction: Theory: 96 hours + Lab/Skill Lab: 48 hours = 144 hours +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | I | 12 | Hematological Alterations | | | | • Review of clinical assessment, pathophysiology and |pharmacology| | | | • Special diagnostic studies | | | | • Hematology conditions requiring neonatal care manage|ment| | | | • Disorders of red blood cells | | | | o Polycythemia | | | | o Anemia | | | | o Sickle cell diseases | | | | • Disorders of white blood cells | | | | o Leucopenia | | | | • Neoplastic disorders | | | | • Disorders of hemostasis | | | | • Platelet disorders | | | | • Coagulation disorders | | | | o Disseminated intravascular coagulation | | | | • Hemorrhagic disease of the newborn | | | | o Vitamin K prophylaxis | | | | o Thrombocytopenia or qualitative defects of platelets| | | | • Anemia, Polycythemia and hyper viscosity | | | | • Arterial and venous thromboses | | | | • Recent advances and development | | II | 8 | Skin Alterations | | | | • Review of Clinical assessment, pathophysiology, and| pharmacology| | | | • Special diagnostic studies | | | | • Skin conditions requiring neonatal care management| | | | o Burns | | | | o Wounds | | | | • Therapeutic management | | | | • Reconstructive surgeries for burns | | | | • Management of wounds | | | | • Recent advances and development | | III | 12 | Multi-system Alterations requiring Neonatal Care | | | | • Review of clinical assessment, pathophysiology, and| pharmacology| | | | • Special diagnostic studies | | | | • Multisystem alteration conditions requiring neonata|l care management| | | | • Trauma | | | | • Sepsis | | | | • Shock | | | | • Multiple Organ Dysfunction | | | | • Systemic inflammatory response syndrome | | | | • Anaphylaxis | | | | • DIC | | | | • Other injuries (Heat, Electrical, Near Hanging, Ne|ar drowning)| | | | • Envenomation | | | | • Drug overdose | | | | • Poisoning | | IV | 10 | Specific Infections in Neonatal Care | | | | • Review of clinical assessment, pathophysiology, and| pharmacology| | | | • Special diagnostic studies | | | | • Specific infection conditions requiring neonatal ca|re management| | | | • HIV/AIDS | | | | • Parent to child transmission | | | | • TORCH | | | | • Tetanus | | | | • SARS | | | | • Rickettsiosis | | | | • Leptospirosis | +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | • Dengue | | | | • Malaria | | | | • Neonatal sepsis | | | | • Rabies | | | | • Avian flu | | | | • COVID-19 | | V | 9 | Metabolic Disorders Alterations requiring Neonatal Ca|re| | | | • Review of clinical assessment, pathophysiology, and| pharmacology| | | | • Special diagnostic studies | | | | • Metabolic conditions requiring neonatal care manage|ment| | | | • Hypoglycemia | | | | • Hyperglycemia | | | | • Hypocalcemia | | | | • Osteopenia of prematurity | | | | • Hypercalcemia | | | | • Hypomagnesemia | | | | • Late metabolic acidosis | | | | • Inborn errors of metabolism (IEM) (Phenylketonuria|)| | | | • Newborn screening | | | | • Neonatal thyroid screening | | VI | 10 | Orthopedic Conditions | | | | • Review of Clinical assessment, pathophysiology, and| pharmacology| | | | • Special diagnostic studies | | | | • Surgical conditions requiring neonatal care management| | | | • Talipes equinovarus (club foot) | | | | • Calcaneus valgus deformity | | | | • Genu recurvatum | | | | • Congenital dislocation of hips | | VII | 10 | Miscellaneous Conditions | | | | • Review of clinical assessment, pathophysiology, and| pharmacology| | | | • Special diagnostic studies | | | | • Surgical conditions requiring neonatal care manage|ment| | | | • Birth injuries | | | | • Cyanosis | | | | • Indications for oxygen therapy | | | | • Retinopathy of prematurity | | | | • Edema and hydrops fetalis | | | | • Ascites | | | | • Sclerema | | | | • Vesiculobullous skin eruptions | | | | • Neonatal erythroderma | | | | • Ichthyosis | | | | • Vascular nevi | | | | • Disorders of pigmentation | | | | • Multiple pregnancy | | | | • Iatrogenic disorders | | VIII | 10 | Neonatal Care in Peri anesthetic Period | | | | • Selection of anesthesia | | | | • General anesthesia | | | | • Anesthetic agents | | | | Peri anesthesia Assessment and Care | | | | • Post anesthesia problems and emergencies requiring| neonatal care| | | | o Respiratory - Airway obstruction, Laryngeal edema,| Laryngospasm, Bronchospasm,| | | | Noncardiogenic pulmonary edema, Aspiration, Hypoxia,| Hypoventilation| | | | o Cardiovascular - Effects of anesthesia on cardiac| function, Myocardial dysfunction,| | | | Dysrhythmias, postoperative hypertension, post operat|ive hypotension| +-------+-------+-------------------------------------------------------+ +-------+-------+-------------------------------------------------------+ | Unit | Hours | Content | +-------+-------+-------------------------------------------------------+ | | | o Thermoregulatory - Hypothermia, shivering, hyperthe|rmia, malignant hyperthermia| | | | o Neurology - Delayed emergence, emergence delirium | | | | o Nausea and vomiting | | IX | 10 | Other Special situations in Neonatal Care | | | | • Rapid response teams and transport of the critically| ill| | | | • Disaster management | | | | • Ophthalmic emergencies - Eye injuries, ROP, Laser t|herapy for ROP| | | | • ENT emergencies - Foreign bodies, stridor, bleeding| , quinsy, acute allergic conditions| | | | • Otoacoustic emission (OAEs) | | | | • BERA test | | | | 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). • Hematological Alterations o Blood transfusion o Bone marrow transplantation o Care of Catheter site o Bone marrow aspiration • Skin Alterations o Burn fluid resuscitation o Burn feeds calculation o Burn dressing o Burns bath o Wound dressing • Multi-system Alterations requiring neonatal care o Triage o Trauma team activation o Administration of anti-snake venom o Antidotes • Specific infections in neonatal care o Isolation precautions o Disinfection and disposal of equipment • Neonatal care - Obstetrics, children o Partogram o Equipment - incubators, warmers • Neonatal care in Peri anesthetic period o Assisting with planned intubation o Monitoring of neonates under anesthesia o Administration of nerve blocks o Titration of drugs - Ephedrine, Atropine, Naloxone, Avil, Ondansetron o Sensory and motor block assessment for neonates on epidural analgesia o Technical troubleshooting of syringe/infusion pumps • Other special situations in neonatal care o Disaster preparedness and protocols Bibliography • Ali A., Ariff S., Rajani R., Khowaja W.H., Leghari A.L., Wali S., Barkat R. & Rahim A. (2021) SNAPPE II Score as a Predictor of Neonatal Mortality in NICU at a Tertiary Care Hospital in Pakistan, Cureus 13(12). e20427. https://doi.org/10.7759/cureus.20427 • Barbeau D.Y. & Weiss M.D. (2017) Sleep Disturbances in Newborns, Children (Basel, Switzerland) 4(10) 90. https://doi.org/10.3390/children4100090 • Hall R.W. & Anand K.J. (2014) Pain management in newborns, Clinics in perinatology 41(4) 895-924. https://doi.org/10.1016/j.clp.2014.08.010 • Kenner C. & Boykova M.V. (2021) Neonatal nursing care handbook: an evidence-based approach to conditions and procedures, Springer Publishing Company • Kenner C., Leslie Altimier D.N.P. & Boykova M.V. (Eds.) (2019) Comprehensive neonatal nursing care, Springer Publishing Company • Klock P., Buscher A., Erdmann A.L., Costa R. & Santos S.V. (2019) Best practices in neonatal nursing care management, Texto & Contexto-Enfermagem, 28, e20170157 • Wyckoff M., Houghton D. & Lepage C. (2009) Neonatal care, New York: Springer Publishing Company Appendix 1 EQUIPMENT LIST FOR NCU A. NEWBORN CARE CORNER +-------+-------------------------------------------------------+-----------+-----------+----------+ | S.No. | Item Description | Essential | Desirable | Quantity | +-------+-------------------------------------------------------+-----------+-----------+----------+ | 1 | Open care system: radiant warmer, fixed height, with tr|olley, | E | | 1 | | | drawers, O2 bottles | | | | | 2 | Resuscitator, hand-operated, neonate, 500 ml | E | | 1 | | 3 | Weighing scale, spring | | | | | 4 | Pump suction, foot operated | E | | 1 | | 5 | Thermometer, clinical, digital, 32-34°C | E | | 1 | | 6 | Light for examination, mobile, 220-12 V | E | | 1 | | 7 | Syringe hub cutter | E | | 1 | +-------+-------------------------------------------------------+-----------+-----------+----------+ B. NEWBORN STABILIZATION UNIT (4 bedded) +-------+-------------------------------------------------------+-----------+-----------+----------+ | S.No. | Item Description | Essential | Desirable | Quantity | +-------+-------------------------------------------------------+-----------+-----------+----------+ | 1 | Open care system: radiant warmer, fixed height, with tr|olley, | E | | 3 | | | drawers, O2 bottles | | | | | 2 | Phototherapy unit, single head, high intensity | E | | 1 | | 3 | Resuscitator, hand-operated, neonate, 500 ml | E | | 2 | | 4 | Laryngoscope set, neonate | E | | 2 | | 5 | Electronic baby-weighing scale 10 kg <5 g> | E | | 1 | | 6 | Suction pump, foot operated | E | | 1 | | 7 | Thermometer, clinical, digital, 32-34°C | E | | 4 | | 8 | Light for examination, mobile, 220-12 V | E | | 4 | | 9 | Syringe hub cutter | E | | 1 | +-------+-------------------------------------------------------+-----------+-----------+----------+ C. SNCU (EQUIPMENT FOR INDIVIDUAL CARE) (12 bedded) +-------+-------------------------------------------------------+-----------+-----------+----------+ | S.No. | Item Description | Essential | Desirable | Quantity | +-------+-------------------------------------------------------+-----------+-----------+----------+ | 1 | Infant care beds | E | | 12 | | 2 | Phototherapy unit, single head, high intensity | E | | 6 | | 3 | Resuscitator, hand-operated, neonate, 250 ml | E | | 2 | | 4 | Resuscitator, hand-operated, neonate, 500 ml | E | | 4 | | 5 | Laryngoscope set, neonate | E | | 6 | | 6 | Suction pump, portable, 220 V, w/access | E | | 2 | | 7 | Suction pump, foot operated | E | | 2 | | 8 | Surgical instrument, suture/SET | E | | 2 | | 9 | Syringe pump, 10, 20, 50 ml, single phase | E | | 3 | | 10 | Oxygen hood, S and M, set of 3 each, including connec|ting tubes| E | | 6 | | 11 | Oxygen supply system | E | | 1 | +-------+-------------------------------------------------------+-----------+-----------+----------+ +-------+-------------------------------------------------------+-----------+-----------+----------+ | S.No. | Item Description | Essential | Desirable | Quantity | +-------+-------------------------------------------------------+-----------+-----------+----------+ | 12 | Oxygen concentrator | | D | 4 | | 13 | Thermometer, clinical, digital, 32-43°C | E | | 12 | | 14 | Electronic baby-weighing scale, 10 kg <5 g> | E | | 4 | | 15 | Pulse oximeter, bedside, neonatal | E | | 6 | | 16 | Stethoscope, binaural, neonate | E | | 12 | | 17 | Sphygmomanometer, neonate, electronic | E | | 6 | | 18 | Light, examination, mobile, 220-12 V | E | | 6 | | 19 | Syringe hub cutter | E | | 2 | | 20 | Measuring tape, vinyl-coated, 1.5 m | E | | 2 | | 21 | Kidney basin, stainless steel, 825 ml | E | | 4 | | 22 | Dressing tray, stainless steel, 300 × 200 × 30 mm | E | | 4 | | 23 | Infusion stand, double hook, on castors | E | | 1 | | 24 | Indicator, TST control spot/PAC-300 | | D | 1 | | 25 | Irradiance meter for phototherapy units | | D | 2 | | 26 | Monitor, vital | | D | 1 | | 27 | ECG unit, 3 channel | | D | 2 | | 28 | Infantometer, Plexi, 32 feet/105 cm | E | | 1 | | 29 | X-Ray, mobile | | D | 1 | | 30 | Transport incubator, basic, with battery and O2, w/o |ventilator| | D | 1 | | 31 | Autoclave, steam, bench top, 20 I, electrical | | D | 1 | | 32 | Laundry washer dryer, combo, 5 kg | | D | | +-------+-------------------------------------------------------+-----------+-----------+----------+ D. GENERAL EQUIPMENT +-------+-------------------------------------------------------+-----------+-----------+----------+ | S.No. | Item Description | Essential | Desirable | Quantity | +-------+-------------------------------------------------------+-----------+-----------+----------+ | 1 | AC (1.5 tonne) | E | | 1 | | 2 | Generator set 25-50 KVA | E | | 1 | | 3 | Refrigerator, hot zone, 110 l | E | | 1 | | 4 | Voltage servo-stabiliser (three phase): 25-50 KVA | E | | 1 | | 5 | Room heater (oil) | | D | 4 | | 6 | Computer with Printer | | D | 1 | | 7 | Spot lamps | E | | 2 | | 8 | Wall clock with seconds hand | E | | 2 | +-------+-------------------------------------------------------+-----------+-----------+----------+ E. EQUIPMENT FOR DISINFECTION +-------+-------------------------------------------------------+-----------+-----------+----------+ | S.No. | Item Description | Essential | Desirable | Quantity | +-------+-------------------------------------------------------+-----------+-----------+----------+ | 1 | Sterilising drum, 165 mm diameter | | | | | 2 | Electric steriliser | | D | 1 | | 3 | Washing machine with dryer | | | | | 4 | Gowns for staff and mothers | E | | 1 | | 5 | Washable slippers | | | | +-------+-------------------------------------------------------+-----------+-----------+----------+ F. LABORATORY EQUIPMENTS +-------+-------------------------------------------------------+-----------+-----------+----------+ | S.No. | Item Description | Essential | Desirable | Quantity | +-------+-------------------------------------------------------+-----------+-----------+----------+ | 1 | Centrifuge, haematocrit, bench top, up to 12000 rpm (r|evolutions| | | | | | per minute) including rotor | | | | | 2 | Microscope, binocular, with illuminator | | D | 1 | +-------+-------------------------------------------------------+-----------+-----------+----------+ +-------+-------------------------------------------------------+-----------+-----------+----------+ | S.No. | Item Description | Essential | Desirable | Quantity | +-------+-------------------------------------------------------+-----------+-----------+----------+ | 3 | Bilirubinometer, total bilirubin, capillary-based | | | | | 4 | Glucometer with Dextrostix | E | | 3 | +-------+-------------------------------------------------------+-----------+-----------+----------+ LAB EQUIPMENT • Additional space (storage, nursing station, doctor’s room and circulation space) - 100% extra of the bed space. • Each infant care space shall contain a minimum of 120 square feet (11.2 square meters), excluding sinks and aisles. • There should be an aisle adjacent to each infant care space with a minimum width of 4 feet (1.2 meters) in multiple beds. • The unit should have 50 square feet neonate care space per baby in the level II. • For level III, neonatal care area of 80-100 square feet, support services area of 80-100 square feet, and circulation area of about 80 square feet is considered as appropriate area - o 500-600 square feet per bed; o 100-120 square feet per neonate care area; o 8 ft difference in between the incubators. • Availability of mother’s room in the nursery is desirable for level II and essential for level III. • Mechanical requirements at each infant care bed, such as electrical and gas outlets, should be organised to ensure safety, easy access and maintenance - o Minimum of 20 simultaneously accessible electrical outlets; o Minimum number of simultaneously accessible gas outlets: Air, Oxy & Vac - 3 each; o Mixture of emergency and normal power for all electrical outlets. Staff Requirements • One neonatologist for 6-12 neonates in the continuing care, intermediate care and intensive care areas. • He should be available on 24 hours bases for consultation. • A ratio of one neonatologist to every 4-5 neonates who requires intensive care ideally round the clock. • Services of other specialists like microbiologist, haematologist, radiologist, and cardiologist and should be available on call. • An anaesthetist capable of administering anaesthesia to neonate. • Pediatric surgeon and pathologists should be available. Nurses Ratio 1. Nurse neonate ratio of 1:1 maintained throughout day and night. 2. A ratio of one nurse for two sick babies not requiring ventilator support may be adequate - - For an ideal nurse neonate ratio, four trained nurses per intensive care bed are needed; - Additional head nurse who is the overall in-charge; - In addition to basic nursing training for level II care, tertiary care requires dedicated, committed and trained staff of the highest qualify. Their training must include training in handling equipment, use of Ventilator and use of mask resuscitations and even endotracheal Intubation, arterial sampling and so on. Disposable Articles Required for the NCU • IV catheter, IV Sets, bacterial filters, feeding tubes, endotracheal tubes • Suction catheters, three-way adopters, umbilical arterial and venous catheters • Syringes, needles ventilator tubing’s, trocar and canula, pressure transducers for invasive blood pressure REFERENCES • NHM GoI and care of the newborn by Dr. Meharban Singh Appendix 2 ASSESSMENT GUIDELINES (including OSCE Guidelines) INTERNAL ASSESSMENT (Theory and Practical) Ist Year 1. Theoretical Basis for Advanced Nursing Practice 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 Neonatal Care Theory: Test papers: 20 marks Written assignment: 5 marks (Literature review/Preparation of research instrument) Journal club: 5 marks (Analysis of research evidence for neonatal care competencies) Total: 30 marks 3. Advanced Skills in Leadership, Management and Teaching Skills Theory: Test papers: 15 marks Journal Club: 5 marks (Trends in Leadership/Management/Teaching) Written assignment: 5 marks (Neonatal care unit workplace violence) Microteaching: 5 marks Total: 30 marks 4. Advanced Pathophysiology & Advanced Pharmacology applied to Neonatal Care 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 any NCU IInd year 1. Foundations of Neonatal Nursing Practice Theory: Test papers and Quiz: 20 Written assignment: 10 marks (NCU 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. Neonatal 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. Neonatal 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 (Develop clinical/care pathway): 10 marks Internal OSCE: 50 marks Total Internal practical: 100 marks End of posting exam can be conducted in any NCU 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. HEALTH ASSESSMENT INTERNAL OSCE: 25 marks CORE COMPETENCY DOMAINS 1. Focused history taking of neonate 2. Focused physical examination of neonate 3. Focused history taking and physical examination of pregnant woman 4. Interpretation of findings and results 5. Monitoring 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 neonate 2. Focused physical examination of neonate 3. Focused history taking and physical examination of pregnant woman 4. Interpretation of history and physical examination findings of neonate 5. Interpretation of results of lab and diagnostic tests of neonate 6. Interpretation of findings and results of pregnant woman 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 IInd year FOUNDATIONS OF NEONATAL NURSING INTERNAL OSCE: 50 Marks CORE COMPETENCY DOMAINS 1. Focused history taking, and physical examination of neonate 2. Interpretation of findings and results of neonate 3. Monitoring competencies (Invasive and noninvasive) 4. Therapeutic interventions (Specific procedural competencies) including drug administration 5. Family education and counseling 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, and physical examination of neonate 2. Interpretation of findings and results of neonate 3. Monitoring competencies (invasive and noninvasive) 4. Development of care plan 5. Therapeutic interventions (specific procedural competencies) including drug administration 6. Family education and counseling 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 NEONATAL NURSING I & II INTERNAL OSCE: 50 marks CORE COMPETENCY DOMAINS 1. Focused history taking, and physical examination of neonate 2. Interpretation of findings and results of neonate 3. Monitoring competencies (Invasive and noninvasive) 4. Therapeutic interventions (Specific procedural competencies) including drug administration 5. Family education and counseling 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, and physical examination of neonate 2. Interpretation of findings and results of neonate 3. Monitoring competencies (Invasive and noninvasive) 4. Therapeutic interventions (Specific procedural competencies) including drug administration 5. Family education and counseling 6. Develops care plan 7. Interpretation of findings and results of lab and diagnostic tests 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 3a CLINICAL LOG BOOK FOR NURSE PRACTITIONER IN NEONATAL NURSING (NPNeoN) PROGRAM (Specific Procedural Competencies/Clinical Skills) Ist year +-------+-------------------------------------------------------+------------------+------+-------------------------+ | S.No. | Skills | Number | Date | Signature of | | | | Performed | | the Preceptor* | +-------+-------------------------------------------------------+------------------+------+-------------------------+ | I | RESEARCH APPLICATION AND EVIDENCE BASED PRACTICE | | | | | 1 | Preparation of research instrument | | | | | 2 | Preparation of a manuscript for publication (Ist / Ind| year) | | | | 3 | Writing systematic review/Literature review | | | | | 4 | Dissertation/EBP Project | 1 | | | | | Topic: | | | | | II | ADVANCED SKILLS IN LEADERSHIP, MANAGEMENT AND TEACHIN|G | | | | 1 | Preparation of staff neonate assignment | | | | | 2 | Preparation of unit budget | | | | | 3 | Preparation of staff duty roster | | | | | 4 | Patient care audit | | | | | 5 | Preparation of nursing care standards and protocols | | | | | 6 | Management of equipment and supplies | | | | | 7 | Monitoring, evaluation, and writing report of infecti|on control| | | | | | practices | | | | | 8 | Micro teaching/parent education sessions | | | | | 9 | Preparation of teaching plan and media for parents of| neonates| | | | | | and staff | | | | | 10 | Planning and conducting OSCE/OSPE | | | | | 11 | Construction of tests | | | | | III | HEALTH ASSESSMENT | | | | | 1 | Comprehensive history taking | | | | | 2 | Neonatal assessment (System wise) | | | | | 2.1 | Respiratory system | | | | | 2.2 | Cardiac system | | | | | 2.3 | Gastrointestinal | | | | | 2.4 | Nervous | | | | | 2.5 | Genitourinary | | | | | 2.6 | Endocrine | | | | | 2.7 | Hematological | | | | +-------+-------------------------------------------------------+------------------+------+-------------------------+ +-------+-------------------------------------------------------+------------------+------+-------------------------+ | S.No. | Skills | Number | Date | Signature of | | | | Performed | | the Preceptor* | +-------+-------------------------------------------------------+------------------+------+-------------------------+ | 2.8 | Musculoskeletal | | | | | 2.9 | Integumentary | | | | | 2.10 | Sensory organs | | | | | 3 | Newborn reflexes | | | | | 3.1 | Sucking reflex | | | | | 3.2 | Moro reflex | | | | | 3.3 | Tonic neck reflex | | | | | 3.4 | Grasp reflex | | | | | 4 | History & physical examination of a pregnant woman | | | | | IV | DIAGNOSTIC PROCEDURES | | | | | 1 | Collecting blood sample | | | | | 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 | Chest X-ray | | | | | 3.2 | ERCP | | | | | 3.3 | PET scan | | | | | 3.4 | Endoscopy | | | | | 3.5 | MRI/CT | | | | | 3.6 | Ultrasound | | | | | 3.7 | EMG | | | | | 3.8 | Echocardiogram | | | | | 3.9 | ECG | | | | | V | BASIC COMPETENCIES | | | | | 1 | Admission | | | | | 2 | Transfer: | | | | | | Care during transfer by air ambulance and surface ambu|lance | | | | 3 | Transport | | | | | 4 | Medico-legal compliance | | | | | 5 | Family education | | | | | 6 | Setting up, use and maintenance of neonatal care equi|pment | | | | 6.1 | Monitors | | | | | 6.2 | Transducer/pressure bag | | | | | 6.3 | Temperature probes | | | | +-------+-------------------------------------------------------+------------------+------+-------------------------+ +-------+-------------------------------------------------------+------------------+------+-------------------------+ | S.No. | Skills | Number | Date | Signature of | | | | Performed | | the Preceptor* | +-------+-------------------------------------------------------+------------------+------+-------------------------+ | 6.4 | SpO2 probes | | | | | 6.5 | Sequential compressing device | | | | | 6.6 | 12-lead ECG monitor | | | | | 6.7 | Syringe pump | | | | | 6.8 | Infusion pump | | | | | 6.9 | Alpha/Air mattress | | | | | VI | SPECIFIC COMPETENCIES | | | | | 1 | Nutritional assessment of neonates | | | | | 2 | Assessment of healthy newborn | | | | | 3 | Assessment of high-risk newborn | | | | | 4 | Newborn Assessment/Care | | | | | 5 | Bowel sounds | | | | | 6 | GRBS | | | | | 7 | Partogram | | | | | 8 | Assisting in KMC | | | | | 9 | Assisting in breast feeding | | | | | 10 | NRP (Neonatal Resuscitation Program) | | | | | 11 | Care of eyes | | | | | 12 | Umbilical cord care/Umbilical cannulation or catheter|ization | | | | 13 | Baby bath | | | | | 14 | Administration of katori/spoon feeding/Paladai, feedi|ng/assisting, with cleft lip & palate| | | | | 15 | Artificial Feeding | | | | | | • NG/Oral | | | | | | • Gastrostomy | | | | | | • Jejunostomy | | | | | 16 | Neonatal Assessment | | | | | 16.1 | History collection | | | | | 16.2 | Physical examination | | | | | 16.3 | Growth & Development Assessment | | | | | | DDST (Denver Developmental Screening Test) | | | | | 16.4 | CRIB (Clinical Risk Index of Babies) | | | | | | CRIB-II (Clinical Risk Index of Babies-II) | | | | | 16.5 | SNAP (Score for Neonatal Acute Physiology) | | | | | | • SNAP-II (Score for Neonatal Acute Physiology-II) | | | | | | • SNAPPE (Score for Neonatal Acute Physiology - | | | | | | Perinatal Extension) | | | | | 16.6 | IV cannulation site Assessment (Phlebitis Scale) and |care | | | | 16.7 | Assessment of neonate through Humpty Dumpty Fall | | | | | | Assessment Scale | | | | | 16.8 | APGAR Score | | | | | 16.9 | New Ballard Score | | | | | 16.10 | Pediatrics Glasgow Coma Scale (PGCS) | | | | | 16.11 | Premature Infant Pain Profile (PIPP) | | | | | 17 | Medication Administration | | | | | 17.1 | Medication administration | | | | | | • Oral | | | | | | • Intravenous | | | | | | • Intramuscular | | | | | | • Intradermal | | | | | 17.2 | Calculation of Fluid & flow rate | | | | | 17.3 | Calculation of Height, Weight, BMI | | | | | 17.4 | Administration of fluids | | | | | 17.5 | Preparation of different strength of fluids | | | | | 17.6 | Instillation - eye , ear, nose | | | | | 17.8 | Drug calculation | | | | | 17.9 | Blood transfusion | | | | | 17.10 | TPN | | | | | 18 | Laminar flow | | | | | 19 | Chest physiotherapy and postural drainage | | | | | 20 | Urinary catheterization and drainage | | | | | 21 | Bowel wash | | | | | 22 | Condom drainage | | | | | 23 | Care of ostomies | | | | | | • Esophagostomy | | | | | | • Gastrostomy | | | | | | • Colostomy | | | | | | • Ureterostomy | | | | | 24 | Administration of Oxygen Therapy by | | | | | | • Tent | | | | | | • Hood | | | | | | • Mask | | | | | | • Nasal prongs | | | | | 25 | Steam inhalation | | | | +-------+-------------------------------------------------------+------------------+------+-------------------------+ *When the student is found competent to perform the skill, it will be signed by the preceptor/faculty. Students: Students are expected to perform the listed skills/competencies many times until they reach level 3 competency, after which the preceptor/faculty 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 can perform that competency without supervision. • Level 2 Competency denotes that the student can perform each competency with supervision. • Level 1 Competency denotes that the student is not able to perform that competency/skill even with supervision. NOTE: 5-10% of procedures that are rare can be practiced in skill lab and attained level 3 competency. Signature of the Program Coordinator/Faculty Signature of the HOD/Principal Appendix 3b CLINICAL LOG BOOK FOR NURSE PRACTITIONER IN NEONATAL NURSING (NPNeoN) PROGRAM (Specific Procedural Competencies/Clinical Skills) IInd year +-------+-------------------------------------------------------+------------------+------+-------------------------+ | S.No. | Skills | Number | Date | Signature of | | | | Performed | | the Preceptor* | +-------+-------------------------------------------------------+------------------+------+-------------------------+ | I | ADVANCED COMPETENCIES | | | | | 1 | Setting up, use and maintenance of Neonatal care | | | | | | equipment | | | | | 1.1 | Ventilator | | | | | 1.2 | Radiant warmer | | | | | 1.3 | Incubator | | | | | 1.4 | ET cuff pressure monitor | | | | | 1.5 | Defibrillator | | | | | 1.6 | Pacemaker | | | | | 1.7 | CRASH trolley | | | | | 1.8 | CPAP/BiPAP | | | | | 1.9 | Phototherapy | | | | | 2 | Triage | | | | | 3 | Monitoring and interpretation of critically ill neonat|es | | | | 3.1 | Arterial blood gas (ABG) | | | | | 3.2 | Oxygen saturation | | | | | 3.3 | Endotracheal tube cuff pressure | | | | | 3.4 | Capnography | | | | | 3.5 | PiCCO | | | | | 3.6 | Hemodynamics | | | | | 3.7 | Electrocardiogram (ECG) | | | | | 3.8 | Intracranial pressure (ICP) | | | | | 3.9 | Invasive BP monitoring | | | | | 3.10 | Non-invasive BP monitoring | | | | | 3.11 | Transthoracic echocardiography | | | | | 4 | Administration of medication | | | | | 4.1 | Sedation | | | | | 4.2 | Muscle relaxant | | | | | 4.3 | Electrolyte infusion | | | | | 4.4 | Insulin infusion | | | | | 4.5 | Inotrope administration | | | | | 4.6 | Thrombolytic drug | | | | | 4.7 | Corticosteroid | | | | | 5 | Management of Cardiovascular Alterations | | | | | 5.1 | Fluid administration (Colloid/Crystalloid) | | | | | 5.2 | Blood and blood product administration | | | | | 5.3 | Insertion and Care of CVP line | | | | | 5.4 | Removal of CVP line | | | | | 5.5 | Assisting with insertion of arterial line | | | | | 5.6 | Care of arterial line | | | | | 5.7 | Removal of arterial line | | | | | 5.8 | Assisting with insertion of pulmonary artery catheter | | | | | 5.9 | Care of neonate with Pacemaker | | | | | 5.10 | Blood collection from arterial line | | | | | 6 | Management of Pulmonary Alterations | | | | | 6.1 | Oropharyngeal airway application | | | | | 6.2 | Laryngeal mask airway | | | | | 6.3 | Assisting with intubation | | | | +-------+-------------------------------------------------------+------------------+------+-------------------------+ +-------+-------------------------------------------------------+------------------+------+-------------------------+ | S.No. | Skills | Number | Date | Signature of | | | | Performed | | the Preceptor* | +-------+-------------------------------------------------------+------------------+------+-------------------------+ | 6.4 | Care of ET tube | | | | | 6.5 | Extubation | | | | | 6.6 | Assisting for tracheostomy insertion | | | | | 6.7 | Tracheostomy care and suctioning | | | | | 6.8 | Endotracheal suctioning - Open | | | | | 6.9 | Endotracheal suctioning - Closed | | | | | 6.10 | Assisting with insertion of chest tube | | | | | 6.11 | Care of neonate with chest drainage | | | | | 6.12 | Chest tube removal | | | | | 6.13 | Nebulization | | | | | 6.14 | Care of neonate on mechanical ventilator | | | | | 6.15 | Non-invasive ventilation | | | | | 6.16 | Connecting to ventilator | | | | | 6.17 | Weaning from ventilator | | | | | 6.18 | Use of T-tube and venturi devices | | | | | 6.19 | Postural drainage | | | | | 6.20 | Weaning from tracheostomy | | | | | 6.21 | Chest physiotherapy | | | | | 7 | Management of Neurological Alterations | | | | | 7.1 | Sensory stimulation | | | | | 7.2 | Consciousness/Coma status monitoring | | | | | 8 | Management of Genitourinary Alterations | | | | | 8.1 | Cannulating for hemodialysis | | | | | 8.2 | Starting and closing of hemodialysis | | | | | 8.3 | Care of neonate on hemodialysis | | | | | 8.4 | Initiating peritoneal dialysis | | | | | 8.5 | Care of neonate on peritoneal dialysis | | | | | 8.6 | Calculation of fluid replacement | | | | | 8.7 | Care of neonate with continuous urinary drainage | | | | | 9 | Management of Gastrointestinal Alterations | | | | | 9.1 | Estimation of dietary allowance | | | | | 9.2 | Therapeutic diet planning | | | | | 9.3 | Enteral nutrition | | | | | 10 | Management of Endocrine Alterations | | | | | 10.1 | Titrating insulin | | | | | 10.2 | Calculation of steroid administration | | | | | 11 | Infection control practices | | | | | | • Universal precautions | | | | | | • Disinfection/sterilization | | | | | 12 | Preparation of standards/policies/protocols | | | | | 13 | Family counselling | | | | | 14 | NALS | | | | | 15 | End of life care | | | | | | • Brain death | | | | | | • Organ donation | | | | | 16 | Ordering Investigations | | | | | 16.1 | ECG | | | | | 16.2 | ABG | | | | | 16.3 | Chest X-ray | | | | | 16.4 | Ultrasound | | | | | 17 | Ordering Treatment/Procedures | | | | | 17.1 | Nebulization | | | | | 17.2 | Chest physiotherapy | | | | | 17.3 | Distal colostomy wash | | | | | 17.4 | Insertion and removal of urinary catheter for female | | | | | | neonates | | | | | 17.5 | Test feeds | | | | | 17.6 | Surgical dressing | | | | | 17.7 | Starting and closing dialysis | | | | +-------+-------------------------------------------------------+------------------+------+-------------------------+ *When the student is found competent to perform the skill, it will be signed by the preceptor/faculty. Students: Students are expected to perform the listed skills/competencies many times until they reach level 3 competency, after which the preceptor/faculty 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 can perform that competency without supervision. • Level 2 Competency denotes that the student can perform each competency with supervision. • Level 1 Competency denotes that the student is not able to perform that competency/skill even with supervision. NOTE: 5-10% of procedures that are rare can be practiced in skill lab and attained level 3 competency. Signature of the Program Coordinator/Faculty Signature of the HOD/Principal Appendix 4 CLINICAL REQUIREMENTS FOR NURSE PRACTITIONER IN NEONATAL NURSING (NPNeoN) PROGRAM Ist year +-------+-------------------------------------------------------+------+-------------------------+ | S.No. | Clinical Requirement | Date | Signature of the | | | | | Preceptor/Faculty | +-------+-------------------------------------------------------+------+-------------------------+ | 1 | Clinical Seminar/Journal Club/Clinical Conference | | | | 1.1 | *APN - Clinical pathway in specific clinical condition|/Application of specific nursing theory) (Clinical Seminar)| | | | | Title of the topic: | | | | 1.2 | *RA - Evidence search for neonatal nursing competenci|es (Clinical Conference/Journal Club)| | | | | Title of the topic: | | | | 1.3 | *LM&T - Trends in Leadership/Management/Teaching | | | | | (Journal Club) | | | | | Title of the topic: | | | | 2 | Clinical Rounds (With Nursing Staff, Faculty, Student|s) - Case/Clinical Presentation| | | | 2.1 | Pathophysiology (Clinical Conditions) | | | | | Name of clinical condition: | | | | 2.2 | Pathophysiology (Clinical Conditions) | | | | | Case Study (Written Report) | | | | | Name of clinical condition: | | | | 2.3 | Pharmacology - Drug Studies (Drugs listed under Stan|ding Orders) - Written Report of 5 Presentations| | | | | (Bedside Presentations) | | | | | Name of the drug: | | | | 2.3.1 | | | | | 2.3.2 | | | | | 2.3.3 | | | | | 2.3.4 | | | | | 2.3.5 | | | | | 2.3.6 | | | | | 2.3.7 | | | | | 2.3.8 | | | | | 3 | Interdisciplinary Clinical Rounds (With Neonatal Doct|ors) - Case/Clinical Presentation| | | | | (Written reports are for submission) | | | | 3.1 | Health Assessment (Neonate) - History & Physical Exam|ination (Two written reports)| | | | 3.1.1 | | | | | 3.1.2 | | | | | 3.1.3 | | | | | 3.1.4 | | | | | 3.1.5 | | | | | 3.2 | Health Assessment (Pregnant Woman) | | | | | (One written report) | | | | 3.3.1 | | | | | 3.3.2 | | | | +-------+-------------------------------------------------------+------+-------------------------+ *Advanced Practice Nursing - APN, Research Application - RA, Leadership, Management and Teaching - LM&T Signature of the Program Coordinator/Faculty Signature of the HOD/Principal CLINICAL EXPERIENCE DETAILS +------------------+---------------------------+------------------------+-------------------------+ | Neonatal Care | Clinical Condition | Number of | Signature of | | Unit (NCU) | | days care given | Faculty/Preceptor | +------------------+---------------------------+------------------------+-------------------------+ | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | +------------------+---------------------------+------------------------+-------------------------+ Signature of the Program Coordinator/Faculty Signature of the HOD/Principal CLINICAL REQUIREMENTS FOR NURSE PRACTITIONER IN NEONATAL NURSING (NPNeoN) PROGRAM IInd year +-------+-------------------------------------------------------+------+-------------------------+ | S.No. | Clinical Requirement | Date | Signature of the | | | | | Preceptor/Faculty | +-------+-------------------------------------------------------+------+-------------------------+ | 1 | Clinical Seminar/Journal Club/Clinical Conference | | | | 1.1 | Foundations of Neonatal Nursing Practice (Clinical Con|ference)| | | | | Title of the topic: | | | | 1.2 | Neonatal Nursing I (Clinical Seminar) | | | | | Title of the topic: | | | | 1.3 | Neonatal Nursing I (Journal Club) | | | | | Title of the topic: | | | | 1.4 | Neonatal Nursing II (Clinical Seminar) | | | | | Title of the topic: | | | | 1.5 | Neonatal Nursing II (Journal Club) | | | | | Title of the topic: | | | | 2 | Clinical Rounds (With Nursing Staff, Faculty, Student|s) - Clinical/Case Presentation| | | | | (Written reports are for submission) | | | | 2.1 | Foundations of Neonatal Nursing Practice | | | | | (Family Education/Counselling) | | | | | Written Report | | | | | Name of the topic: | | | | 2.2 | Foundations of Neonatal Nursing Practice (Clinical/Car|e Pathway)| | | | | Name of the topic: | | | | 2.3 | Neonatal Nursing I (Clinical Presentation) | | | | | Name of clinical condition: | | | | 2.4 | Neonatal Nursing I (Case Study Report) | | | | | Name of clinical condition: | | | | 2.5 | Neonatal Nursing II (Clinical Presentation) | | | | | Name of clinical condition: | | | | 2.6 | Neonatal Nursing II (Case Study Report) | | | | | Name of clinical condition: | | | | 2.7 | Drug Studies (Drugs listed under Standing Orders) | | | | | Bedside Presentation | | | | | (Five written reports) | | | | | Name of drug: | | | | 2.7.1 | | | | | 2.7.2 | | | | | 2.7.3 | | | | | 2.7.4 | | | | | 2.7.5 | | | | | 2.7.6 | | | | | 2.7.7 | | | | | 2.7.8 | | | | | 3 | Interdisciplinary Clinical Rounds (With Neonatal Doct|ors) - Clinical/Case Presentation| | | | 3.1 | Neonatal Nursing I (Clinical Presentation) | | | | | Name of clinical condition: | | | | 3.2 | | | | | 3.3 | | | | | 3.4 | | | | | 3.5 | (Case Study Report) | | | | 3.6 | Neonatal Nursing II | | | | 3.7 | | | | | 3.8 | | | | | 3.9 | (Case Study Report) | | | | 3.10 | Written Report (Developed Clinical/Care Pathway) | | | +-------+-------------------------------------------------------+------+-------------------------+ Note: Clinical presentation can be written for case study report. Signature of the Program Coordinator/Faculty Signature of the HOD/Principal CLINICAL EXPERIENCE DETAILS +------------------+---------------------------+------------------------+-------------------------+ | Neonatal Care | Clinical Condition | Number of | Signature of | | Unit (NCU) | | days care given | Faculty/Preceptor | +------------------+---------------------------+------------------------+-------------------------+ | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | +------------------+---------------------------+------------------------+-------------------------+ Signature of the Program Coordinator/Faculty Signature of the HOD/Principal Appendix 5 STANDING ORDERS NURSE PRACTITIONER IN NEONATAL NURSING (NPNeoN) PROGRAM Nurse practitioners are prepared and qualified to assume responsibility and accountability for the care of critically ill neonates. They collaborate with Neonatal Intensivists, physicians, surgeons and specialists to ensure accurate therapy for neonates with high acuity needs. On completion of the program, the NPs will be permitted to administer drugs listed in standing orders as per the institutional protocols/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 in any of the NCUs. Catecholamines 1. Adrenaline 2. Noradrenaline 3. Dopamine 4. Dobutamine Antidysrhythmic 5. Adenosine 6. Amiodarone 7. Lidocaine/Xylo card Adrenergic agent 8. Ephedrine Bronchodilators 9. Aminophylline 10. Deriphyllin Non depolarizing skeletal muscle relaxant 11. Atracurium (Vecuronium, Pancurium) Anticholinergic 12. Atropine sulphate Antihistamine 13. Avil Antihypertensive 14. Clonidine 15. Glycerin trinitrate 16. Isoptin Corticosteroid 17. Hydrocortisone 18. Dexamethasone Antiepileptic 19. Levit racetam 20. Phenytoin Sedatives & relaxants 21. Valium 22. Midazolam 23. Morphine sulphate 24. Pentazocine lactate (Fortwin) 25. Pethidine hydrochloride 26. Propofol Electrolytes & acid base correction agents 27. Soda bicarbonate 8.4% 28. Soda bicarbonate 7.5% 29. Magnesium sulphate 30. Potassium chloride Additional drugs that can be administered specific to each NCU are as follows - 1. Norad 2. Milrinone 3. Sildenafil 4. Fentanyl 5. Lasix 6. PGE 1 7. Vasopressin 8. Insulin The following investigations and therapies may be ordered by the Nurse Practitioner +-------------------------------------------------------+-------------------------------------------------------+ | Ordering Investigations | Ordering Therapies | +-------------------------------------------------------+-------------------------------------------------------+ | • ECG | • Nebulization | | • ABG | • Chest physiotherapy | | • Chest X-Ray | • Distal colostomy wash | | • Basic Biochemistry investigations - Hb, | • Insertion and removal of urinary catheter for female| | PCV, TIBC, WBC Total, WBC | neonates | | differentials, ESR, Electrolytes, platelets, | • Test feeds | | PT, aPTT, bleeding and clotting time, | • TEDS | | procalcitonin, D-dimer, creatinine, HbA1c, | • Surgical dressing | | AC, PC, HDL, LDL, TIG, Cholesterol | • Starting and closing dialysis | | total, HIV, HbsAg, HCV | • Administration of TPN infusion with written order | | • Basic Microbiology investigations - blood | • Application of ichthammol glycerin/magnesium sulph|ate dressing for thrombophlebitis/extravasation| | samples for culture and sensitivity, tips of | • Pin site care for neonates on external fixators | | vascular access and ET tube for culture | • Isometric and isotonic exercises | +-------------------------------------------------------+-------------------------------------------------------+ Dr. T. Dileep Kumar President, INC [ADVT.-III/4/Exty./844/2024-25] 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.