In exercise of the powers conferred by sub section 1 of Section 16 of Indian Nursing Council Act

The Gazette of India EXTRAORDINARY PART III—Section 4 PUBLISHED BY AUTHORITY No. 807] NEW DELHI, TUESDAY, DECEMBER 5, 2023/AGRAHAYANA 14, 1945 CG-DL-E-13122023-250532 INDIAN NURSING COUNCIL NOTIFICATION New Delhi, the 28th November, 2023 INDIAN NURSING COUNCIL (NURSE PRACTITIONER IN EMERGENCY AND TRAUMA CARE – POSTGRADUATE RESIDENCY PROGRAM) REGULATIONS, 2022 F.No. 11-1/2022-INC.— In exercise of powers conferred under Section 18(1)(k) read with Section 21 of the Indian Nursing Council Act, 1947 (48 of 1947), the Indian Nursing Council, with the previous sanction of the Central Government, hereby makes the following regulations for the Nurse Practitioner in Emergency and Trauma Care (NPETC) Postgraduate Residency Program, namely:- CURRICULUM I. THEORETICAL BASIS FOR ADVANCED PRACTICE NURSING Hours of Instruction: Theory: 30 hours COMPETENCIES 1. Applies concepts, theories and models relevant to advanced nursing practice. 2. Integrates theoretical frameworks to guide advanced practice nursing role. 3. Analyzes the historical development and current trends in advanced practice nursing. 4. Applies leadership and management principles in advanced practice roles. II. RESEARCH APPLICATION AND EVIDENCE BASED PRACTICE IN EMERGENCY CARE COMPETENCIES 1. Critically appraises research evidence relevant to emergency and trauma nursing practice. 2. Applies evidence based practice principles to improve patient outcomes in emergency and trauma care. 3. Participates in the conduct and dissemination of nursing research. III. ADVANCED SKILLS IN LEADERSHIP, MANAGEMENT AND TEACHING SKILLS COMPETENCIES 1. Demonstrates leadership and management skills relevant to Emergency and Trauma Care units. 2. Applies teaching-learning principles for patient, family and staff education. IV. ADVANCED PATHOPHYSIOLOGY AND ADVANCED PHARMACOLOGY RELEVANT TO EMERGENCY AND TRAUMA NURSING Hours of Instruction: Theory: 90 hours (Pathophysiology: 40 hours; Pharmacology: 50 hours) ADVANCED PATHOPHYSIOLOGY COMPETENCIES 1. Applies knowledge of altered physiology to the assessment and management of patients with emergency and trauma conditions. 2. Correlates pathophysiological changes with clinical presentation of common emergency and trauma conditions system-wise (cardiovascular, respiratory, neurological, renal, gastrointestinal, endocrine, musculoskeletal, integumentary, hematological, and multi-system alterations). ADVANCED PHARMACOLOGY RELEVANT TO EMERGENCY AND TRAUMA NURSING Hours of Instruction table (Units I-XVII covering, in sequence): Unit I Introduction to Clinical Pharmacology; Unit II Pharmacology relevant to Cardiovascular emergencies; Unit III Pharmacology relevant to Respiratory emergencies; Unit IV Pharmacology relevant to Neurological emergencies; Unit V Pharmacology relevant to Renal and Genitourinary emergencies; Unit VI Pharmacology relevant to Gastrointestinal emergencies; Unit VII Pharmacology relevant to Endocrine emergencies; Unit VIII Pharmacology relevant to Hematological emergencies; Unit IX Pharmacology relevant to Musculoskeletal and Integumentary emergencies; Unit X Pharmacology of Sedatives, Analgesics and Muscle relaxants; Unit XI Pharmacology of Antimicrobials; Unit XII Pharmacology in Obstetric and Gynaecological emergencies; Unit XIII Pharmacology in Paediatric emergencies; Unit XIV Pharmacology in Psychiatric emergencies; Unit XV Pharmacology of Antidotes and management of poisoning/toxicology; Unit XVI (3 hours) Pharmacology and Trauma related emergencies — Medications used in pain management of tetanus prophylaxis, prophylactic antibiotics, and medication used in traumatic shock, cranio-facial injuries, musculoskeletal and spinal injuries, cardio-thoracic injuries, abdominal injuries, injuries during pregnancy, and paediatric trauma; Unit XVII (2 hours) Pharmacology in Disaster Management — medications used in the management of various disasters. Bibliography: Johnson, T.J. (2012). Critical Care Pharmacotherapeutics, Jones & Bartlett Learning: United States of America. Wynne, A.L., Woo, T.M. & Olyaei, A.J. (2007). Pharmacotherapeutics for Nurse Practitioner Prescribers (2nd ed.), Philadelphia: Davis. V. ADVANCED HEALTH/PHYSICAL ASSESSMENT IN EMERGENCY AND TRAUMA NURSING COMPETENCIES 1. Applies the physical assessment principles in developing appropriate system wise examination skills 2. Uses advanced health assessment skills to differentiate between variations of normal and abnormal findings 3. Orders screening and diagnostic tests based on the examination findings and institutional protocols 4. Analyzes the physical examination findings and results of various investigations and works collaboratively with emergency physicians for development of diagnoses 5. Documents assessment, diagnosis, and management and monitors follow up care in partnership with health care team members, patients, and families Hours of Instruction: Theory: 70 hours; Practical/Lab: 48 hours Unit I (4 hrs) Introduction: History; Physical examination. Unit II (6 hrs) Cardiovascular system: Cardiac history; Physical examination; Cardiac laboratory studies (biochemical markers, hematological studies); Cardiac diagnostic studies (ECG, echocardiography, stress testing, radiological imaging). Unit III (6 hrs) Respiratory system: History; Physical examination; Respiratory monitoring (ABG, pulse oximetry, end-tidal CO2 monitoring); Respiratory diagnostic tests (chest radiography, ventilation perfusion scanning, pulmonary angiography, bronchoscopy, thoracentesis, sputum culture, pulmonary function test). Unit IV (6 hrs) Nervous system: Neurological history; General physical examination; Assessment of cognitive function; Assessment of cranial nerve function; Motor assessment; Sensory assessment (dermatome assessment); Neurodiagnostic studies (CT scan, MRI, PET, EEG, EMG). Unit V (6 hrs) Genitourinary system: History; Physical examination; Assessment of renal function; Assessment of electrolytes and acid base balance; Assessment of fluid balance. Unit VI (4 hrs) Gastrointestinal system: History; Physical examination; Nutritional assessment; Laboratory studies (liver function studies, blood parameters, stool test); Diagnostic studies (radiological and imaging studies, endoscopic studies). Unit VII (4 hrs) Endocrine system: History, physical examination, laboratory studies and diagnostic studies of hypothalamus and pituitary gland, thyroid gland, parathyroid gland, adrenal gland. Unit VIII (4 hrs) Hematological system: History; Physical examination; Laboratory studies (blood parameters); Diagnostic studies (bone marrow aspiration). Unit IX (2 hrs) Integumentary system: History; Physical examination; Pathological examination (tissue examination). Unit X (6 hrs) Musculoskeletal system: History; Physical examination (gait assessment, joint assessment); Laboratory studies (blood parameters - inflammatory enzymes, uric acid); Diagnostic studies (radiological and imaging studies). Unit XI (5 hrs) Reproductive system (Male & Female): History; Physical examination; Laboratory studies; Diagnostic studies. Unit XII (4 hrs) Sensory Organs: History; Physical examination; Laboratory studies; Diagnostic studies (radiological and imaging studies, endoscopic studies). Unit XIII (5 hrs) Assessment of children: Growth and development; Nutritional assessment; Specific system assessment. Unit XIV (5 hrs) Assessment of Obstetric patients: History; Physical assessment; Laboratory studies (blood parameters); Diagnostic studies (ultrasonogram, partogram). Unit XV (3 hrs) Assessment of Psychiatric patients: History; Psychiatric assessment; Laboratory studies (blood parameters). List of skills to be practiced in the skill lab (46 hours include demonstration by the faculty and practice by the students): Comprehensive history taking; Focused history taking (system wise); Comprehensive physical examination; Focused physical examination (system wise); Monitoring clinical parameters (system wise) including invasive BP monitoring, multi-parameter monitors, ECG, PiCCO, peripheral vascular status, ABG, pulse oximetry, ETCO2, ICP, GCS, cranial nerve assessment, pain (VAS) and sedation (RASS) score, 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); Ordering and interpretation of screening and diagnostic tests (system wise) (Enclosed Appendix 3); Assessment of children-neonate and child; Assessment of pregnant women. Bibliography: Bickley, L.S. & Szilagyi, P.G. (2013). Bates' Guide to Physical Examination and History Taking (11th ed.), New Delhi: Lippincott Williams and Wilkins. Rhoads, J. (2006). Advanced Health Assessment and Diagnostic Reasoning, Philadelphia: Lippincott Williams & Wilkins. Wilson, S.F. & Giddens, J.F. (2006). Health Assessment for Nursing Practice (4th ed.), St. Louis, Missouri: Saunders Elsevier. Emergency and Trauma Specialty Courses (Foundations of Emergency and Trauma Nursing Practice, Emergency and Trauma Nursing I and Emergency and Trauma Nursing II) COMPETENCIES 1. Applies advanced concepts of Emergency and Trauma 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 and prepares care/clinical pathways in assessment and management of patients with acute conditions. 4. Consults with and is consulted by other health care professionals. 5. Provides nursing care related to management of acute illness and injuries, health protection, disease prevention, anticipatory guidance, counseling, 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 emergency and trauma care. 9. Practices independently within the legal framework of the country towards the interest of patients, families and communities. 10. Develops practice that is based on scientific evidence. 11. Uses applicable communication, counseling, advocacy and interpersonal skills to initiate, develop and discontinue therapeutic relationships. 12. Creates and maintains a safe therapeutic environment using risk management strategies and quality improvement. 13. Adapts practice to the social, cultural and contextual milieu. VII. FOUNDATIONS OF EMERGENCY AND TRAUMA NURSING PRACTICE Hours of Instruction: Theory: 96 hours, Practical/Skill Lab: 48 hours Unit I (10 hrs) Introduction to Emergency and Trauma Nursing: Introduction to the course; Review of anatomy and physiology of vital organs (brain, spinal cord, lungs, heart, kidney, liver, pancreas, thyroid, adrenal and pituitary gland); Historical review; Definition, principles, trends and scope of Emergency and Trauma Nursing; Nursing Emergency and Trauma care unit set up (resuscitation area, observation area, equipment, supplies, beds and accessories, use and care of various types of monitors & ventilators, flow sheets, supply lines and the environment); Personnel in Emergency and Trauma care unit (nursing staff, doctors, EMTs, social workers, ancillary staff); Technology in Emergency and trauma care; Healthy work environment; Future challenges in Emergency and Trauma Nursing. Unit II (5 hrs) Concept of Holistic care applied to Emergency and Trauma Nursing practice: Application of nursing process and integrated care/clinical pathways in caring for patients requiring emergency and trauma care; Admission and monitoring of patients; Overview of unit management (ensure adequate airway, circulation, temperature, pain management, fluid/electrolyte balance, initial symptomatic management, organ protection, infection control); Restraints in emergency and trauma care; Death in Emergency and trauma care unit: End of life/care of dying, care of family, organ donation; Transport of emergency and trauma patients (by air ambulance and surface ambulance); Stress and burnout syndrome among health team members. Unit III (10 hrs) Appraisal of patients with emergency and trauma conditions: Assessment (emergency, respiratory, cardiac, renal, neurological, gastrointestinal, endocrine, musculoskeletal, integumentary, eye/ENT, in children, in pregnant women, in patients with psychiatric conditions) and Monitoring (ABG, capnography, hemodynamics, ECG, GCS, RASS, pain score, Braden score). Unit IV (14 hrs) Advanced Concepts and Principles of Emergency and trauma Care: Principles of cardio-pulmonary-brain resuscitation (BLS, ACLS, PALS, NALS); Airway management; Oxygenation and oximetry, care of patient with oxygen delivery devices; Ventilation and ventilator support (including humidification and inhaled drug therapy), care of patient with invasive and non-invasive ventilation; Circulation and perfusion (including hemodynamic evaluation and waveform graphics); Types of shock and management; Glycemic control, care of patient with glycemic imbalances. Unit V (8 hrs) Pain assessment and Management: Pain in emergency and trauma conditions; types, theories; physiology, systemic responses and psychology of pain; acute pain services; pain assessment (scales, behavior, verbalization); pharmacological management (opioids, benzodiazepines, propofol, alpha agonist, tranquilisers, neuromuscular blocking agents); nonpharmacological management; TENS. Unit VI (8 hrs) Psychosocial and spiritual alterations: assessment and management: Stress and psychoneuroimmunology; Post-traumatic stress reaction; Acute psychosis, anxiety, agitation, delirium; Alcohol withdrawal syndrome and delirium tremens; Collaborative management; Sedation and relaxants; Spiritual challenges; Coping with stress and illness; Care of family; Crisis counseling and communication. Unit VII (4 hrs) Patient and family education and counseling: Challenges; Informational needs; Counseling needs; Crisis counseling techniques. Unit VIII (6 hrs) Fluid, electrolyte and acid base alterations: Review; Assessment and management of imbalances. Unit IX (4 hrs) Thermoregulation and management: Review; Hyperthermia and hypothermia related emergencies; Management. Unit X (5 hrs) Infection control in emergency care: Nosocomial infection including MRSA and other recently identified strains; Disinfection, sterilization, standard safety measures, prophylaxis for staff; Antimicrobial therapy review. Unit XI (6 hrs) Legal and ethical issues in Emergency and trauma care - Nurse's role: Legal issues (legislations/regulations, Consumer Protection Act, negligence & malpractice, medical futility, constitutional law, legal responsibilities of nurses, medico-legal aspects, MLC policies/protocol/documentation) and Ethical issues (Code of Ethics and professional conduct/practice standards of Nursing in India, ethical principles, ethical issues and decision making including withholding treatment and managing scarce resources, brain death/organ donation/counseling, DNR, euthanasia, living will). Unit XII (8 hrs) Quality assurance: Design of ETC units; quality assurance models; standards/protocols/policies/procedures; infection control policies; standard safety measures; nursing audit; staffing. Unit XIII (3 hrs) Evidence based practice in Emergency and Trauma Nursing: Evidence based practice; barriers to implementation; strategies to promote implementation. (5 hrs) Class tests. List of skills to be practiced in the skill lab (46 hours): CPR (BLS and ACLS); Airway management (head tilt/chin lift, jaw thrust, suctioning, oropharyngeal/nasopharyngeal airway, laryngeal mask airway, endotracheal intubation, cricothyroidotomy, tracheostomy); Oxygenation and oximetry (pulse oximetry, venous oximetry, PF ratio, capnography, non-invasive ventilation devices - nasal catheters/cannulae, face mask, Venturi devices, NIV, T-pieces); Ventilation and ventilator support (setting up, connecting, weaning, extubation, humidifiers, nebulizers, MDI/DPI inhalation therapy); Circulation and perfusion (non-invasive and invasive BP monitoring, venous pressure, arterial and central line insertion/removal, PiCCO, ECG, waveforms); Fluids and electrolytes (fluid calculation/administration of crystalloids and colloids, blood and blood products, inotrope calculation/titration/administration - cardiac glycosides, sympathomimetics, phosphodiesterase inhibitors, electrolyte correction, fluid dispenser/syringe pump/infusion pumps); Evaluation of acid base status (ABG, correction of acidosis/alkalosis); Thermoregulation (temperature probes, management of hyper/hypothermia); Glycemic control (GRBS monitoring, insulin sliding scale/infusion, management of hyper/hypoglycemia); Pharmacological management of pain/sedation/agitation/delirium (calculation, loading and infusion of morphine, fentanyl, midazolam, lorazepam, diazepam, propofol, clonidine, dexmedetomidine, haloperidol, ketamine; epidural analgesia procedures); Counseling; Family education. VIII. EMERGENCY AND TRAUMA NURSING – I Hours of Instruction: Theory: 96 hours, Practical: 48 hours Unit I (5 hrs) Introduction: Review of anatomy & physiology of vital organs; Triage (history, concepts, systems, acuity rating systems, process, ambulance triage, documentation, reassessment, nurse role/qualifications); Ambulance system (air and surface patient transport, types, transport process, CATS Ambulance). Unit II (12 hrs) Cardiovascular Emergencies: Review of clinical assessment/pathophysiology/pharmacology; special diagnostic studies; conditions requiring emergency management (arrhythmias, heart block/dysrhythmias, coronary heart disease, contractility disorders, infectious/inflammatory cardiac disorders, vascular/thromboembolic disorders); cardiovascular therapeutic management (defibrillation, cardioversion, ICDs, pacemakers, thrombolytic therapy, radiofrequency ablation, PTCA, cardiac surgery - CABG/MICAS/valvular/vascular/transplant, IABP, VAD, ECMO); recent advances. Unit III (12 hrs) Respiratory Emergencies: Review; special diagnostic studies; pulmonary conditions (acute inflammatory/infectious disorders - asthma, status asthmaticus, bronchitis, bronchiolitis, pneumonia, empyema, COPD exacerbation, lung abscess, pleurisy/effusion; ALI, atelectasis, ARDS, pneumothorax; complications of tumours); pulmonary therapeutic management (bronchial hygiene, chest tube insertion/care, mechanical ventilation); recent advances. Unit IV (12 hrs) Neurological Emergencies: Review; special diagnostic studies; conditions (brain abscess, encephalitis, Guillain-Barre syndrome, meningitis, Bell's palsy, temporal arteritis; tumours; carotid dissection, stroke, subarachnoid haemorrhage, subdural/extradural haematomata, TIA, venous sinus thrombosis; coma, raised ICP, peripheral neuropathies, encephalopathy, seizures/status epilepticus; brain death criteria); neurologic therapeutic management (ICP monitoring/management, external ventricular drain, stroke protocol/team, thrombolysis, mechanical thromboembolectomy, craniotomy, organ donation process); recent advances. Unit V (12 hrs) Genitourinary and Renal Emergencies: Review; special diagnostic studies; nephrology conditions (epididymo-orchitis, glomerulonephritis, pyelonephritis, prostatitis, STDs, UTIs; acute renal failure, nephrotic syndrome, nephrolithiasis, uraemia; ischaemia/bleeding; dialysis/transplant comorbidities, urological complications, haemolytic uraemic syndrome); nephrology therapeutic management (indwelling urethral catheter insertion, suprapubic cystostomy, testicular torsion reduction, renal replacement therapy - haemodialysis/peritoneal dialysis); recent advances. Unit VI (10 hrs) Gastrointestinal Emergencies: Review; special diagnostic studies; conditions (appendicitis, cholecystitis, cholangitis, diverticulitis, IBD exacerbations, gastritis, gastroenteritis, GERD, hepatitis, pancreatitis, peptic ulcer, peritonitis; hepatic disorders/failure; foreign bodies, hernia strangulation, intestinal obstruction; ischaemic colitis, GI bleeding, mesenteric ischaemia; complications of devices/surgical procedures); GI therapeutic management (gastric lavage, peritoneal lavage, abdominal paracentesis); recent advances. Unit VII (8 hrs) Musculoskeletal Emergencies: Review; special diagnostic studies; conditions (bursitis, cellulitis, complications of systemic rheumatic diseases, necrotising fasciitis, osteomyelitis, soft tissue infections; osteoporosis complications; pathological fractures); orthopedic therapeutic management (antibiotic therapy, immobilization); recent advances. Unit VIII (10 hrs) Endocrine Emergencies: Review; special diagnostic studies; conditions (adrenal insufficiency/crisis; hyperosmolar hyperglycaemic state, hypoglycaemia, ketoacidosis; myxoedema coma, thyroid storm; neuroendocrinology of stress; SIADH); endocrine therapeutic management (insulin sliding scale); recent advances. Unit IX (10 hrs) Hematological Emergencies: Review; special diagnostic studies; conditions (anaemia in acute illness, sickle cell crisis; lymphoma/leukaemia complications; neutropenic fever, infections in immuno-compromised patients; coagulation factor deficiency, DIC, drug-induced bleeding, ITP, TTP; transfusion reactions); hematology therapeutic management (autologous blood transfusion); recent advances. (5 hrs) Class tests. List of skills to be practiced in the skill lab (69 hours): Cardiovascular alterations (thrombolytic therapy, use of defibrillator/PiCCO/pacemakers/IABP/ECMO); Pulmonary alterations (tracheostomy care, nebulization, chest physiotherapy, chest tube insertion/drainage); Neurological alterations (GCS/ICP monitoring, sedation score, cervical collar/traction application, brain death evaluation); Genitourinary and Renal alterations (indwelling urethral catheter, suprapubic cystostomy, haemodialysis, peritoneal dialysis, testicular torsion reduction); Gastrointestinal alterations (NG tube insertion, abdominal paracentesis); Musculoskeletal alterations (splints/immobilizing devices); Endocrine alterations (cortisol/sugar/thyroid sample collection, corticosteroid and insulin administration/calculation); Hematological alterations (reverse barrier technique, blood transfusion, care of invasive lines, bone marrow aspiration). IX. EMERGENCY AND TRAUMA NURSING – II Hours of Instruction: Theory: 96 hours, Practical: 48 hours Unit I (10 hrs) Sense Organ Emergencies: Review; special diagnostic studies; Skin (burns, wounds; wound management, fluid resuscitation in burns); Eye (conjunctivitis, periorbital cellulitis, uveitis; retinal artery/vein occlusion, vitreous haemorrhage; foreign bodies; acute glaucoma, acute vision loss, retinal detachment; eye irrigation, foreign body removal); ENT (acute infections/inflammations, complications of tumours/airway obstruction, foreign bodies, angio-oedema, epiglottitis, laryngitis, paratonsillar abscess, Ludwig's angina; airway management techniques, oropharynx/larynx inspection, otoscopy, tracheostomy tube insertion/replacement, foreign body removal); recent advances. Unit II (10 hrs) Multi system alterations requiring emergency care: Shock; sepsis; systemic inflammatory response syndrome; multiple organ dysfunction; anaphylaxis; DIC; other injuries (heat, electrical, near hanging, near drowning); flora and fauna injuries (bites/stings); high-altitude medical problems; temperature-related emergencies; near-drowning/dysbarism/diving/marine fauna complications; recent advances. Unit III (5 hrs) Toxicology: General principles of toxicology and management of poisoned patients; principles of drug interactions; poisoning (drug overdose, chemicals, corrosives, herbal); forensic issues (relevant legislation in India, history/physical examination, evidence recognition/preservation/sample collection, reporting/referral - child abuse/neglect, gunshot/penetrating wounds, elder abuse, sexual assault allegations); therapeutic management (antidotes, gastric lavage, decontamination); recent advances. Unit IV (10 hrs) Specific infections in emergency care: Common viral/bacterial infections; food/water-borne infectious diseases; air-borne infectious diseases; HIV/AIDS; malaria, dengue; rabies; sepsis and septic shock; tetanus; pandemic (flu scares, Avian Influenza A(H5N1), COVID-19); recent advances. Unit V (10 hrs) Emergency care in Obstetrics and Gynaecology: Physiological changes in pregnancy; antenatal emergencies (hyperemesis gravidarum, ectopic pregnancy, antepartum haemorrhage - abruptio placentae/placenta praevia, pregnancy induced hypertension); intra-partum emergencies (eclampsia, obstructed labor, ruptured uterus); post-partum emergencies (PPH, obstetrical shock, puerperal sepsis, HELLP syndrome, DIC, amniotic fluid embolism); gynecological emergencies (ovarian cyst/abscess/torsion, PID, sexual assault, vaginal bleeding); therapeutic management (emergency delivery, management of PPH); recent advances. Unit VI (10 hrs) Emergency care in children: Prominent anatomical/physiological differences and implications; medical and surgical emergencies (respiratory, cardiovascular, neurological, gastrointestinal, genitourinary, endocrine); infectious disease emergencies; skin lesions and burns; poisoning, foreign bodies, drowning; accidents; shocks; selected pediatric challenges (ventilatory issues, medication administration, pain management, child abuse/sexual assault, interaction with children and families). Unit VII (6 hrs) Emergency care in Psychiatry: Review of psychiatric assessment, pathophysiology, pharmacology; common psychiatric emergencies (acute psychosis, anorexia/bulimia complications, anxiety/panic attacks, conversion disorders, deliberate self-harm/suicide attempt, depressive illness, personality disorders, substance/drug/alcohol abuse); sexual assault; post-traumatic stress disorder; therapeutic management (electro convulsive therapy). Unit VIII (15 hrs) Trauma Management: Concepts in trauma care, biomechanics of injury, trauma prevention; initial assessment & early management of trauma; immediate management of pelvic trauma, resuscitation, transport of pregnant women; management of airway in trauma, dental/facial injuries, cardio-thoracic injuries, traumatic shock, head injuries, cranio-facial injuries, musculoskeletal/spinal injuries, abdominal/pelvic injuries, poly trauma, paediatric trauma, geriatric trauma, pain management (narcotics, local anaesthesia, nerve blocks), post-trauma rehabilitation, role of nurse in trauma management; therapeutic management (endotracheal intubation, cricothyroidotomy, ICD insertion, massive transfusion protocol, crush injury protocol, wound management, pain management techniques, immobilisation techniques); recent advances. Unit IX (10 hrs) Disaster management: Introduction; concepts & principles; types of disaster; terminologies; disaster triage; hazard identification and risk analysis; disaster management cycle; community and in-hospital disaster management; mass casualty management; psychosocial aspects; ethics; policies and authorities (international, national, state, institutional); recent advances. Unit X (5 hrs) Pre-hospital care: EMS organisation; ambulance policies/protocol/administration/staffing/resources; paramedic training and function; collaboration with other emergency services (government, police, fire department, NGOs); Transportation of the critically ill patient (telecommunication and telemedicine procedures, preparation, standing orders, monitoring and treatment during transportation). (5 hrs) Class tests. List of skills to be practiced in the skill lab (69 hours): Sense organs alterations (burn fluid resuscitation, burn feeds calculation, burn dressing, burns bath, wound dressing, foreign body removal - eye/ear/nose/throat, eye irrigation); Multi system alterations (administration of anti-snake venom, administration of antidotes, gastric lavage, cooling/warming techniques, toxicology, eye irrigation, skin decontamination, forensic sample collection); Specific infections (isolation precautions, disinfection and disposal of equipment); Emergency care in Obstetrics and Gynaecology (obstetrical assessment/partogram, vaginal examination using speculum, use of incubators/warmers, assessment of sexual assault victim); Emergency care in Paediatrics (paediatric airway management, PALS, intraosseous cannulation); Emergency care in Psychiatry (psychiatric assessment); Trauma management (airway management techniques in trauma, ICD insertion, fluid resuscitation, intraosseous cannulation, focused assessment with sonography in trauma, splinting, log rolling, wound management, suturing, reduction of fractures/dislocation of joints, nerve blocks); Disaster management (formulate protocol for in-hospital disaster management, hazard vulnerability mapping, training community volunteers, decontamination); Pre-hospital care (checklist for transfer of critically ill patient). Note: The skills listed under the Specialty courses such as Foundations of Emergency and Trauma Nursing Practice, Emergency and Trauma Nursing I and Emergency and Trauma Nursing II are taught by the faculty in skill lab. The students after practicing them in the lab, will continue to practice in the Emergency and Trauma Care (ETC) Unit. The log book specifies all the requirements to be completed and the list of skills that are to be signed by the preceptor once the students develop proficiency in doing the skills independently. Learning Resources 1. List of Textbooks: Ablash K.P.P. (2019). Emergency Medicine, Best Practices at CMC (EMAC) (2nd ed.), Jaypee Brothers Publications. Brunner and Suddarths (2014). Text Book of Medical Surgical Nursing, Vol. 1 (13th ed.), South Asian Edition, Published by Wolters Kluwer. Daniel Limmer, Michael F. O'keefe. Emergency Care (12th ed.), Pearson Education, Inc., 2011. Fraser M. Diane & Cooper A Margaret (2001). Myles Text Book for Midwives (14th ed.), Churchill Livingstone, Edinburgh. Hickey, A. Joanne (2003). The Clinical Practice of Neurological and Neurological Nursing (5th ed.), Lippincott Company, Philadelphia. John, G., Subramani, K., Peter, J.V., Pitchamuthu, K. & Chacko, B. (2011). Essentials of Critical Care (8th ed.), Christian Medical College: Vellore. Kathleen Sanders Jordan, Emergency Nursing Care Curriculum (5th ed.), Philadelphia. W.B. Saunders Company. Karen A., McQuillan, Eileen Whalen (2008). Trauma Nursing. Morton, P.G. & Fontaine, D.K. (2013). Critical Care Nursing: A Holistic Approach (9th ed.), Lippincott Williams and Wilkins: Philadelphia. Nelson (2011). Text book of Paediatrics (19th ed.), Elsevier Publications, Philadelphia. Newberry, Lovene (2003). Sheehy's Emergency Nursing – Principles and Practices (6th ed.), Mosby St. Louis. Patrica Kunz Howard, Rebeeca A. Steinmann. Sheehy's Emergency Nursing Principles and Practice (6th ed.), Elsevier. Perrin, K.O. (2009). Understanding the Essentials of Critical Care Nursing. New Jersey: Pearson Education. Rosens E, John Marx (2006). Emergency Medicine Concepts & Clinical Practice (6th ed.), Mosbys Elsevier. Suresh David (2012). Textbook of Emergency Medicine (2nd ed.), Wolterscluwer, Lippincott, Williams & Williams. Tintinalli, E. Judith (2000). Emergency Medicine (5th ed.), McGraw Hill New York. Walsh, Mike & Kent, Andrew (2001). Accident and Emergency Nursing (4th ed.), MPS Books Limited Bodmin, Cornwall. 2. List of Journals: Journal of Emergency Nursing; The Advanced Emergency Nursing Journal (AENJ). 3. List of Electronic Materials: Nursecom; Emergency nursing resources (ena.org). 4. Other learning materials: BLS and CPR complete CD package; Electronic materials provided by the faculty like e-lectures and e-books. Recommended Course to Complete: BLS; ACLS; ATLS; PALS. APPENDIX 1 EQUIPMENT LIST FOR A TEN BEDDED EMERGENCY AND TRAUMA UNIT 1. Patient trolley with mattress – 10 2. IV stand – 10 3. Over bed trolley – 5 4. Dressing trolley (Small) – 5 5. Dressing trolley (medium) – 2 6. Syringe pump – 20 7. Infusion pump – 15 8. Monitors – 11 (10 patients; 1 stock) 9. Transport monitor/pulse oximeter – 2 10. Ventilators – 5 11. Portable ventilators – 1 12. ABG machine – 1 13. ECG machine – 1 14. Ultrasound machine – 1 15. Doppler machine – 1 16. Defibrillator – 2 17. Blood warmer – 1 18. LEAD shield – 1 19. Crash cart – 2 20. OR trolley – 4 21. Safe slider – 2 22. Computer – 4 23. Printers – 2 24. Bain circuit – 12 25. Oxygen flow meter – 15 26. Suction port with jar – 15 27. Air flow meter/pulmoaid – 2 28. Refrigerator – 2 (1 drugs, 1 other use) 29. Metal foot step/foot stool – 5 30. UPS – 1 31. Spot light – 2 32. Labelling machine – 1 33. Glucometer – 2 34. Ambu bag with different sizes – 10 sets 35. Intubating videoscope – 1 36. Trays with sterile sets/disposable sets for various procedures (e.g. insertion of central venous catheter, tracheostomy etc.) 37. Minimum standards for Indian ETCU (As per Indian Health facility Guidelines, 2014): The following areas are required for smooth functioning of Emergency and Trauma Unit — Reception and Triage; Ambulance Bay; Decontamination facility; Resuscitation Area; Acute treatment bay; Minor Operating room area; Step down facility; Short stay ward; Isolation unit; Acute psychiatric unit; Patient toilet/shower; Consultation areas; Laboratory area; Pharmacy; Staff Station; Staff lounge; Staff toilet and changing room facility; Store room; Patient trolley bay; Clean and dirty utility room. APPENDIX 2 ASSESSMENT GUIDELINES (including OSCE Guidelines) INTERNAL ASSESSMENT (Theory and Practical) I Year 1. Theoretical Basis for Advanced Practice Nursing: College examination of theory only 50 marks (Test paper/Quiz 10; Written assignment/term paper 10; Clinical seminar 5; Final theory college exam 25; Total 50). Internal practical OSCE 25; Total internal practical 50. 2. Research Application and Evidence Based Practice in Emergency Care: Test papers 20; Written assignment 5; Journal club 5; Total 30. 3. Advanced Skills in Leadership, Management and Teaching Skills: Test papers 15; Journal club 5; Written assignment 5; Microteaching 5; Total 30. 4. Advanced Pathophysiology & Advanced Pharmacology relevant to Emergency and Trauma Nursing: Test papers and Quiz 20 (Pathophysiology 10, Pharmacology 10); Drug studies 5; Case presentation/study report 5; Total 30 Marks. 5. Advanced Health/Physical Assessment: Theory - Test papers 20, Written assignment 10, Total 30; Practicum - Clinical performance evaluation 10, End of posting exam (OSCE) 10, Case presentation/study report 5, Internal OSCE 25, Total internal practical 50. End of posting exam can be conducted in Emergency and Trauma Unit. II Year 1. Foundations of Emergency and Trauma Nursing: Theory - Test papers/Quiz 20, Written assignment 10 (ED protocols), Total 30; Practicum - Clinical performance evaluation 20, End of posting exam (OSCE) 10, Drug studies 10, Case presentation/study report 5, Case presentation 5, Internal OSCE 50, Total internal practical 100. 2. Emergency and Trauma Nursing I: Theory - Test papers/Quiz 20, Clinical Seminar and Journal club 10, Total 30; Practicum - Clinical performance evaluation 20, End of posting exam (OSCE) 10, Clinical presentation 10, Case study report 10, Internal OSCE 50, Total internal practical 100. 3. Emergency and Trauma Nursing II: Theory - Test papers 20, Clinical Seminar 10, Total 30; Practicum - Clinical performance evaluation 20, End of posting exam (OSCE) 10, Clinical presentation 10, Case study report (developed clinical/care pathway) 10, Internal OSCE 50, Total internal practical 100. End of posting exam can be conducted in Emergency and Trauma Unit. 4. Dissertation: Practicum 50 marks. EXTERNAL (FINAL) EXAMINATION (As per schedule in syllabus): Theory - Short answer and essay type questions (Essay 2x15=30, Short answers 5x6=30, Very short 5x2=10). OSCE GUIDELINES FOR INTERNAL AND EXTERNAL PRACTICAL EXAMINATION I Year: I. Health Assessment - Internal OSCE 25 marks (core competency domains: focused history/physical examination of adult and pediatric patient, interpretation of findings/results, monitoring of clinical parameters; 5 stations - 4+1 rest, 10 min each, 5 marks per station = 20, oral exam 5, total 25); External OSCE 50 marks (7 core competency domains; 10 stations - 8+2 rest, 10 min each, 5 marks per station = 40, oral exam 10, total 50). On completion of procedural competencies in log book and clinical requirements, the NP student is qualified to appear for final practical examination. II Year: I. Foundations of Emergency and Trauma Nursing - Internal OSCE 50 marks (4 core competency domains; 5 stations - 4+1 rest, 10 min, 10 marks per station = 40, oral exam 10, total 50); External OSCE 100 marks (6 core competency domains; 10 stations - 8+2 rest, 10 min, 10 marks per station = 80, oral exam 20, total 100). II & III. Emergency and Trauma Nursing I & II - Internal OSCE 50 marks (4 core competency domains; 5 stations - 4+1 rest, 10 min, 10 marks per station = 40, oral exam 10, total 50); External OSCE 100 marks (7 core competency domains including drug administration and therapeutic interventions; 10 stations - 8+2 rest, 10 min, 10 marks per station = 80, oral exam 20, total 100). CLINICAL LOG BOOK FOR NURSE PRACTITIONER (NP) IN EMERGENCY AND TRAUMA CARE PROGRAM APPENDIX 3a – Clinical Log Book – I Year (Procedural Competencies/Skills) I. Research Application and Evidence Based Practice: preparation of research instrument; writing systematic/literature review; preparation of manuscript for publication; dissertation. II. Leadership, Management, and Teaching: preparation of staff patient assignment; preparation of unit budget; preparation of staff duty roster; patient care audit; management of equipment and supplies; monitoring/evaluation/report writing related to infection control; preparation of teaching plan and media; micro teaching/patient education sessions; planning and conducting OSCE/OSPE; construction of tests. III. Health Assessment: comprehensive history taking; comprehensive physical examination; focused history taking (system wise); focused physical examination (system wise - respiratory, cardiac, gastrointestinal, nervous, genitourinary, endocrine, hematological, musculoskeletal, integumentary, sensory organs); age specific history & physical examination (neonate, child, adult, geriatric); history & physical examination of a pregnant woman. IV. Diagnostic Procedures: collecting blood sample for laboratory tests (biochemistry, clinical pathology, microbiology, ABG); assisting procedures (paracentesis, thoracentesis, lumbar puncture, liver biopsy, renal biopsy, bone marrow aspiration); witnessing procedures (ERCP, PET scan, upper GI scopy, colonoscopy, MRI/CT, ultrasound, EEG, EMG, echocardiogram); DSA procedures (aneurysm repair, endovascular embolization, thrombectomy, nephrostomy). V. Basic Competencies: admission; transfer; transport; setting up/use/maintenance of basic emergency and trauma care equipment (monitor, transducer, temperature probes, SpO2 probes, sequential compressing device, 12-lead ECG monitor, blood warmer, fluid warmer, ET cuff pressure monitor, syringe pump, infusion pump); monitoring and interpretation of critical parameters (ABG, oxygen saturation, ET cuff pressure, capnography, hemodynamics, ECG, ICP, invasive/non-invasive BP monitoring, PiCCO, peripheral vascular status, GCS, sedation score, pain score, Braden score, bowel sounds, GRBS, partogram, chest x-ray). Note: When the student is found competent to perform the skill, it will be signed by the preceptor. Students are expected to perform the listed skills/competencies many times until they reach level 3 competency, after which the preceptor signs against each competency. Level 3 competency denotes that the NP student is able to perform that competency without supervision. Level 2 competency denotes ability to perform with supervision. Level 1 competency denotes inability to perform even with supervision. APPENDIX 3b – Clinical Log Book – II Year: Advanced Competencies including setting up/use/maintenance of emergency care equipment (ventilator, defibrillator, pacemaker, crash trolley, CPAP/BiPAP); triage; family education and counseling; discharge/LAMA; medico-legal compliance; end of life care (brain death, organ donation); after life care; care during transfer by ambulance; infection control practices; standard precautions; disinfection/sterilization; BLS; ACLS; preparation of policies/standards/protocols; administration of medication (includes standing orders) I & II Year - catecholamines (adrenaline, noradrenaline, dopamine, dobutamine), antidysrhythmics (adenosine, amiodarone, lidocaine/xylocard), bronchodilators (aminophylline, deriphylline, magnesium sulphate), skeletal muscle relaxant (succinyl choline), anticholinergic (atropine sulphate), antihistamine (avil), antihypertensives (isoptin), corticosteroids (hydrocortisone, dexamethasone), antiepileptics (levitracetam, phenytoin), muscle relaxants & sedatives (midazolam, morphine sulphate, pentazocin lactate/fortwin, pethidine hydrochloride, propofol), electrolyte and acid base correction (soda bicarbonate 8.4%, magnesium sulphate, potassium chloride, 3% saline), epidural analgesia, PCA analgesia, additional drugs (antidotes, anti-snake venom); management of cardiovascular alterations (initiating IV access, IV fluid/blood product administration, TED stocking, CVP line insertion/care/removal, arterial line insertion/care/removal, pulmonary artery catheter assistance, pacemaker care, arterial line blood collection); management of pulmonary alterations (oropharyngeal/laryngeal mask airway application, ET intubation/care/extubation, tracheostomy assistance/care/suctioning/removal/weaning, chest tube assistance/care/removal, nebulization, mechanical/non-invasive ventilation care, ventilator setup/weaning, T-tube/Venturi devices, postural drainage, chest physiotherapy, bronchoscopy assistance); management of neurological alterations (increased ICP management, consciousness/coma monitoring, brain death evaluation); management of genitourinary alterations (suprapubic catheter insertion, hemodialysis/peritoneal dialysis care, testicular detorsion); management of gastrointestinal alterations (dietary allowance estimation, therapeutic diet planning, enteral nutrition, parenteral nutrition/TPN administration); management of endocrine alterations (insulin therapy calculation/titration/administration, steroid calculation/administration); ordering investigations (ECG, ABG, chest X-ray, ultrasound, basic biochemistry/microbiology investigations); ordering procedures/treatment (nebulization, oxygen therapy, chest physiotherapy, IV fluids infusion, NG tube insertion, urinary catheter insertion, surgical dressing, suture removal, Icthammol Glycerin/Magnesium Sulphate dressing, isometric/isotonic exercises, hot and cold applications). APPENDIX 4 CLINICAL REQUIREMENTS FOR NP IN EMERGENCY AND TRAUMA CARE PROGRAM I YEAR: Clinical Seminar/Journal Club/Clinical Conference (APN clinical pathway seminar, RA evidence search journal club, L,M&T leadership/management/teaching journal club); Clinical Rounds (case/clinical presentation - pathophysiology of clinical conditions, case study written report, pharmacology drug studies - 5 written bedside presentations); Interdisciplinary Clinical Rounds with ED doctors (health assessment adult - two written reports, health assessment pediatric - one written report, health assessment pregnant woman - one written report). Clinical Experience Details table (ETC Unit/ICU, Clinical Condition, Number of days care given, Signature of Faculty/Preceptor). II YEAR: Clinical Seminar/Journal Club/Clinical Conference (Foundations of Emergency and Trauma Nursing Practice clinical conference, Emergency and Trauma Nursing I clinical seminar and journal club, Emergency and Trauma Nursing II clinical seminar and journal club); Clinical Rounds (Foundations - family education/counseling written report, emergency care pathway; Emergency and Trauma Nursing I - clinical condition, case study report; Emergency and Trauma Nursing II - clinical condition, case study report, written report on developed clinical/emergency care pathway); Interdisciplinary Clinical Rounds with ED doctors for Emergency and Trauma Nursing I & II. Clinical Experience Details table. APPENDIX 5 STANDING ORDERS Nurse practitioners are prepared and qualified to assume responsibility and accountability for the patients requiring emergency and trauma care. They collaborate with emergency physicians, trauma surgeons and specialists to ensure accurate therapy for patients 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 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 in Emergency and Trauma care units: Catecholamines: 1. Adrenaline 2. Noradrenaline 3. Dopamine 4. Dobutamine Antidysrhythmic: 5. Adenosine 6. Amiodarone 7. Lidocaine/Xylocard Adrenergic agent: 8. Ephedrine Bronchodilators: 9. Aminophylline 10. Deriphylline Non depolarizing skeletal muscle relaxant: 11. Atracurium (Vecuronium, Pancurium) Anticholinergic: 12. Atropine Sulphate Antihistamine: 13. Avil Antihypertensive: 14. Clonidine 15. Glycerine trinitrate 16. Isoptin Corticosteroid: 17. Hydrocortisone 18. Dexamethasone Antiepileptic: 19. Levitracetam 20. Phenytoin Sedatives & relaxants: 21. Valium 22. Midazolam 23. Morphine Sulphate 24. Pentazocin Lactate (Fortwin) 25. Pethidine Hydro Chloride 26. Propofol Electrolytes & acid base correction agents: 27. Soda bicarbonate 8.4% 28. Soda bicarbonate 7.5% 29. Magnesium sulphate 30. Potassium chloride The following investigations and therapies may be ordered by the NPs: ORDERING INVESTIGATIONS: ECG; ABG; Chest X ray; Basic Bio chemistry investigations – Hb, PCV, TIBC, WBC Total, WBC differentials, ESR, Electrolytes, platelets, PT, APTT, bleeding and clotting time, procalcitonin, D dimer, creatinine, HbA1C, AC, PC, HDL, LDL, TIG, Cholesterol total, HIV, HbsAg, HCV; Basic Microbiology investigations – blood and urine samples for culture and sensitivity. ORDERING THERAPIES: Nebulization; Chest physiotherapy; Insertion and removal of urinary catheter for female patients; TEDS; Surgical dressing; Starting and closing dialysis; Application of Icthammol Glycerin/Magnesium Sulphate dressing for Thrombophlebitis/extravasation; Pin site care for patients on external fixators; Isometric and isotonic exercises. INSTITUTIONAL STANDING ORDERS AND PROTOCOLS In every hospital, the standing orders for drug administration with specific dosage to be administered during emergency situations can be made available as guidelines for NPETC graduates. The NP students will be trained to administer these drugs under supervision by preceptors/NP faculty. The protocols for ordering selected investigations and carrying out specific therapeutic procedures can also be available in every hospital that trains NPETC students. Dr. T. DILEEP KUMAR, President, INC [ADVT.-III/4/Exty./589/2023-24]