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

REGD. No. D. L.-33004/99 The Gazette of India CG-DL-E-23102024-258163 EXTRAORDINARY PART III—Section 4 PUBLISHED BY AUTHORITY No. 839] NEW DELHI, MONDAY, OCTOBER 21, 2024/ASVINA 29, 1946 [ADVT.-III/4/Exty./608/2024-25] INDIAN NURSING COUNCIL NOTIFICATION New Delhi, the 7th October, 2024 INDIAN NURSING COUNCIL (POST BASIC DIPLOMA IN CARDIOTHORACIC SPECIALTY NURSING - RESIDENCY PROGRAM) REGULATIONS, 2023 F.No. 11-1/2024-INC (I).—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 (Post Basic Diploma in Cardiothoracic Specialty Nursing - Residency Program) Regulations, 2023. 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. POST BASIC DIPLOMA IN CARDIOTHORACIC SPECIALTY NURSING - RESIDENCY PROGRAM I. INTRODUCTION The National Health Policy document (NHP, 2017) emphasizes the need to expand tertiary care services, prepare specialist nurses and standardization of clinical training for nurses. Responding to this, the Council planned to redesign the existing specialist nursing programs making it as a one-year post basic diploma residency programs utilizing competency-based training approach. Post Basic Diploma in Cardiothoracic Nursing - Residency Program includes revised guidelines that aim to prepare specialist nurses who can provide competent care to patients with cardiothoracic disorders whose diagnostic, treatment and care needs are complex and intensive. Cardio related problems of the Indians are fast becoming major health problems owing to the rapid change in the life style. It has caused a great concern among the health professionals to meet this challenge. It affects all levels of the people. Since 1983 the NHP has guided the health care system in meeting the needs of the people to a great extent. The policy recognizes the need for establishing the training courses for the super-specialty nurses required for tertiary care institutions. Post Basic Diploma in Cardiothoracic Nursing - Residency Program is designed to prepare specially trained Cardiothoracic Nurses. The outcome of the program will be to have more nurses prepared as cardiothoracic nurses for providing competent nursing care in various health care settings. II. PHILOSOPHY The Council believes that registered nurses need to be trained in cardiothoracic nursing in clinical settings in order to provide competent care to patients with cardiothoracic problems. Expanding roles of nurses and advances in technology necessitates additional training to prepare them for effective participation in cardiothoracic care. III. CURRICULAR FRAMEWORK The Post Basic Diploma in Cardiothoracic Specialty Nursing is a one-year residency program and its curriculum is conceptualized encompassing short foundational courses and major specialty courses for specialty nursing practice. The foundations to cardiothoracic specialty nursing practice such as professionalism, communication, patient education and counselling, clinical leadership and resource management, and evidence based & applied research are short courses that aim to provide the students with the knowledge, attitude and competencies essential to function as accountable, safe and competent specialist nurses. The major specialty courses are organized under Cardiothoracic Specialty Nursing I and Cardiothoracic Specialty Nursing II to include context/introduction to cardiothoracic nursing, basic sciences applied to cardiothoracic nursing (application of basic science knowledge in the diagnosis and treatment of clinical conditions under cardiothoracic specialty nursing), nursing management including assessment, diagnosis, treatment and specialized interventions (in management of specific clinical conditions) and patient safety and quality including specialty/illness considerations. The curricular framework for the residency program is illustrated in the following figure 1. POST BASIC DIPLOMA IN CARDIOTHORACIC SPECIALTY NURSING – RESIDENCY PROGRAM Foundations to Cardiothoracic Nursing Courses Cardiothoracic Specialty Nursing Courses +-----------------------------+------------------------------------------------+--------------------------------------+ | Professionalism | COURSES Context/Introduction to specialty | Basic sciences applied to specialty | | | nursing practice | care | +-----------------------------+------------------------------------------------+--------------------------------------+ | Communication, patient | | Nursing Management incl. assessment | | education & counseling | | and specialized interventions | +-----------------------------+------------------------------------------------+--------------------------------------+ | Clinical leadership and | | | | resource management | Cardiothoracic Specialty Nursing education for | Patient safety & quality, and Illness | | | Specialist Practice | specific considerations | +-----------------------------+------------------------------------------------+--------------------------------------+ | Evidence based and applied | | | | research | | | +-----------------------------+------------------------------------------------+--------------------------------------+ ONE-YEAR RESIDENCY PROGRAM (For Registered Nurses & Midwives) Theory – 10% & Practicum – 90% (Skill Lab + Clinical) Figure 1. Curricular Framework for Cardiothoracic Specialty Nursing – Residency Program IV. AIM/PURPOSE & COMPETENCIES Aim The program is designed to prepare nurses with specialized skills, knowledge and attitude in providing quality care to patients with cardiothoracic disorders. It further aims to prepare technically qualified and trained specialist nurses who will function effectively and optimally at cardiothoracic centres of tertiary/quaternary hospitals providing high standards of care. Competencies On completion of the program, the cardiothoracic specialist nurse will be able to: 1. Demonstrate professional accountability for the delivery of nursing care as per the Council standards that is consistent with moral, altruistic, legal, ethical, regulatory and humanistic principles in cardiothoracic practice. 2. Communicate effectively with patients, families and professional colleagues fostering mutual respect and shared decision making to enhance health outcomes. 3. Educate and counsel patients and families to participate effectively in treatment and care and enhance their coping abilities through crisis and bereavement. 4. Demonstrate understanding of clinical leadership and resource management strategies and use them in cardiothoracic care and settings promoting collaborative and effective teamwork. 5. Identify, evaluate and use the best current evidence in cardiothoracic care and treatment coupled with clinical expertise and consideration of patient's preferences, experience and values to make practical decisions in cardiothoracic nursing practice. 6. Participate in research studies that contribute to evidence-based cardiothoracic nursing care interventions with basic understanding of research process 7. Apply basic sciences in the assessment, diagnosis and treatment of the physiological, physical, psychological, social and spiritual problems of patients and their families with cardiothoracic disorders. 8. Describe the concepts and principles of cardiothoracic nursing. 9. Demonstrate skills in advanced cardiac life support. 10. Apply nursing process in caring for patients with cardiothoracic disorders. 11. Communicate effectively with patients having cardiothoracic problems and their family members. 12. Demonstrate skills in management of cardiothoracic services/units. 13. Participate effectively as a member of the cardiac care team. 14. Make a plan for organization of cardiac and thoracic units. 15. Provide end of life care promoting comfort and dignity respecting individual cultural and spiritual needs and differences. 16. Teach and supervise nurses and allied health workers. V. PROGRAM DESCRIPTION AND SCOPE OF PRACTICE The Post Basic Diploma in Cardiothoracic Specialty Nursing – Residency Program is designed to prepare registered nurses (GNM or B.Sc.) with specialized knowledge, skills and attitude in providing advance quality care to patients with cardiothoracic disorders and their families. Emphasis is laid on clinical competency with relevant theory. The theory component comprises 10% and practicum 90% (Clinical & Lab). On completion of the program and certification, and registration as additional qualification with respective SNRC, the cardiothoracic specialist nurses should be employed only in cardiothoracic unit of a multi-specialty hospital. They will be able to practice as per the competencies trained during the program particularly the specialized procedural competencies/clinical skills as per the log book of the Council syllabus. The specialist nurses can be privileged to practice those specialized procedural competencies by the respective institution as per institution protocols. Specialist nurse cadres/positions should be created at government/public/private sectors. The diploma will be awarded by respective Examination Board/SNRC/University approved by the Council. VI. MINIMUM REQUIREMENTS/GUIDELINES FOR STARTING THE POST BASIC DIPLOMA IN CARDIOTHORACIC SPECIALTYT NURSING-RESIDENCY PROGRAM The program may be offered at 1. College of Nursing offering degree programs in nursing attached to parent hospital having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art cardiothoracic units with optimum monitoring and life support equipment/facilities required to provide effective care to patients with cardiothoracic disorders and specialized nursing care facilities. OR Hospitals offering DNB/Fellowship programs in cardiothoracic surgery having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art cardiac and thoracic care units/CT intensive care units with optimum monitoring and life support equipment/facilities required to provide effective care to patients with cardiothoracic conditions and specialized nursing care facilities. 2. The above eligible institution shall get recognition from the concerned SNRC for Post Basic Diploma in Cardiothoracic Specialty Nursing for the particular academic year, which is a mandatory requirement. 3. The Council shall after receipt of the above documents/proposal would then conduct statutory inspection of the recognized training nursing institution under Section 13 of the Act in order to assess the suitability with regard to availability of teaching faculty, clinical and infrastructural facilities in conformity with Regulations framed under the provisions of the Act. 1. Teaching Faculty a. Full time teaching faculty in the ratio of 1:10. b. Minimum number of faculty should be two. c. Qualification and Number: i. M.Sc. Nursing with Medical Surgical Nursing/Cardiothoracic Specialty Nursing - 1 ii. Post Basic Diploma in Cardiothoracic Specialty Nursing with Basic B.Sc. Nursing/P.B.B.Sc. Nursing - 1 d. Experience: Minimum three years of clinical experience in Cardiothoracic Specialty Nursing. e. Guest Faculty: Multi-disciplinary in related specialities. f. Preceptors: • Nursing Preceptor: Full time qualified GNM with six years of experience in Cardiothoracic Specialty Nursing or B.Sc. Nursing with two years of experience in Cardiothoracic Specialty Nursing or M.Sc. Nursing with one year of Cardiothoracic Specialty Nursing experience working in any of the cardiothoracic units/ICUs. • Medical Preceptor: Specialist doctor with PG qualification (with 3 years' post PG experience/faculty level/consultant level preferable). • Preceptor Student Ratio: Nursing 1:10, Medical 1:10 (Every student must have a medical and nursing preceptor) 2. Budget There should be budgetary provision for staff salary, honorariums for guest faculty, and part time teachers, clerical assistance, library and contingency expenditure for the program in the overall budget of the institution. 3. Physical and Learning Resources at Hospital/College a. One classroom/conference room at the clinical area b. Skill lab for simulated learning at hospital/college. Skill Lab Requirements are listed in Appendix-1. c. Library and computer facilities with access to online journals: i. College library having current books, journals and periodicals related to Cardiothoracic Specialty Nursing, anatomy & physiology, microbiology, pharmacology, pathophysiology, Nursing Administration, Nursing Education, Nursing Research and Statistics. OR Permission to use medical college/hospital library having current books, journals and periodicals related to Cardiothoracic Specialty Nursing, anatomy & physiology, microbiology, pharmacology, pathophysiology, Nursing Administration, Nursing Education, Nursing Research and Statistics. ii. Computer with internet facility. d. E-Learning facilities e. Teaching Aids - Facilities for use of: i. Overhead Projectors ii. Video viewing facility iii. LCD Projector iv. CDs, DVDs and DVD players v. Appropriate equipment, manikins and simulators for skill learning f. Office facilities: i. Services of typist, peon, Safai Karmachari ii. Facilities for office, equipment and supplies such as • Stationery • Computer with printer • Xerox machine • Telephone and Fax 4. Clinical Facilities a. Parent specialty hospital/tertiary hospital having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art cardiothoracic unit/intensive care units with optimum monitoring and life support equipment/facilities required to provide effective care to patients with cardiothoracic disorders and specialized nursing care facilities. b. Hospital must have a minimum of 20 specialty beds including cardiothoracic ICU (Minimum of 10 ICU beds) with advanced diagnostic, treatment and care facilities. c. Regional centres/cardiothoracic specialty hospitals having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art cardiothoracic unit/intensive care units with optimum monitoring and life support equipment/facilities required to provide effective care to patients with cardiothoracic disorders and specialized nursing care facilities. d. Nurse staffing of units as per the Council recommended norms. e. Student patient ratio: 1:1-2. 5. Admission Terms and Conditions/Entry Requirements The student seeking admission to this program should: a. Be a registered nurse (RN & RM) or equivalent with any SNRC having NUID number. b. Possess a minimum of one-year clinical experience as a staff nurse preferably in the cardiothoracic unit prior to enrolment. c. Be physically fit. d. Selection must be based on the merit obtained in an entrance examination and interview held by the competent authority. e. Nurses from other countries must obtain an equivalence certificate from the Council before admission. 6. Number of Seats For hospital having 200 beds and 20 specialty beds, number of seats = 10-20, For hospital having 500 beds and more with 30 specialty beds, the number of seats = 15-30. 7. Number of Candidates 1 candidate for 1-2 specialty beds. 8. Salary a. In-service candidates will get regular salary. b. Stipend/Salary for the other candidates as per the salary structure of the hospital where the program is conducted. VII. EXAMINATION REGULATIONS AND CERTIFICATION EXAMINATION REGULATIONS Examining and Diploma Awarding Authority: Respective Examination Board/SNRC/University approved by the Council. 1. Eligibility for appearing for the Examination a. Attendance: Theory & Practical - 80%. However, 100% Clinical attendance have to be completed prior to certification. b. Candidate who successfully completes the necessary requirements such as log book and clinical requirements is eligible and can appear for final examination. 2. Practical Examination a. OSCE: Objective Structured Clinical Examination (OSCE) type of examination will be conducted alongside viva (oral examination) both in the internal and final examination. (Detailed guidelines are given in guidebook.) b. Observed Practical/Clinical: Final internal and external examination will also include assessment of actual clinical performance in real settings including viva and mini clinical evaluation exercise for 3-4 hours (Nursing process application and direct observation of procedural competencies). Minimum period of assessment in the clinical area is 5-6 hours. (Evaluation guidelines are given in guidebook.) c. Maximum number of students per day = 10 students d. Practical Examination should be held in clinical area only e. The team of practical examiners will include one internal examiner [(M.Sc. faculty with two years of experience in teaching the respective specialty program/M.Sc. faculty (Medical Surgical Nursing) with 5 years of Post PG experience], one external examiner (nursing faculty with the same qualification and experience stated as above) and one medical internal examiner who should be preceptor for specialty program. f. The practical examiner and the theory examiner should be the same nursing faculty or from the same specialty. 3. Standard of Passing a. In order to pass, a candidate should obtain at least 60% marks in aggregate of internal assessment and external examination both together, in each of the theory and practical papers. Less than 60 % is considered fail. b. Students will be given opportunity of maximum of 3 attempts for passing. c. If the student fails in either theory or practical, he/she needs to appear for the exam failed either theory or practical only. CERTIFICATION a. TITLE: Post Basic Diploma in Cardiothoracic Specialty Nursing b. A diploma is awarded by Examination Board/SNRC/University approved by the Council, upon successful completion of the prescribed study program, which will state that i. Candidate has completed all the courses of study under the Post Basic Diploma in Cardiothoracic Specialty Nursing - Residency Program ii. Candidate has completed 80% theory and 100% clinical requirements iii. Candidate has passed the prescribed examination. VIII. SCHEME OF EXAMINATION +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ | Courses | Internal Assessment Marks | External Assessment Marks | Total Marks | Exam Hours | +================================================+============================+============================+=============+============+ | A. Theory (Experiential/Residential Learning) | | | | | +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ | Cardiothoracic Specialty Nursing | 25 | 75 | 100 | 3 | | (Part I & Part II) | (10+15) | (35+40) | | | | {Part I - Cardiothoracic Specialty Nursing I | | | | | | including Foundations to Cardiothoracic | | | | | | Specialty Nursing practice, Part II – | | | | | | Cardiothoracic Specialty Nursing II} | | | | | +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ | B. Practicum (Cardiothoracic Specialty Nursing) | 75 | 150 | 225 | Minimum | | • OSCE including Viva | (25+50) | (50+100) | | 5-6 hours | | • Observed Practical/Clinical (Direct | (OSCE-25 & | (OSCE-50 & | | in the | | observation of actual performance at real | Observed Practical-50) | Observed Practical-100) | | clinical | | settings) including viva - mini clinical | | | | area | | evaluation exercise for 3-4 hours (Nursing | | | | | | process application and direct observation | | | | | | of procedural competencies) | | | | | +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ | Grand Total | 100 | 225 | 325 | | +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ Detailed guidelines given in Guidebook. IX. PROGRAM ORGANIZATION/STRUCTURE 1. Courses of Instruction 2. Implementation of Curriculum 3. Clinical Practice (Residency Posting) 4. Teaching Methods 5. Methods of Assessment 6. Log Book & Clinical Requirements 1. Courses of Instruction 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| Theory | 40 Hours | Lab/Skill Lab | Clinical | | (hours) | | (hours) | (hours) | +=================+==========+===============+==============+ | I Foundations to Cardiothoracic Specialty Nursing Practice | 40 | | | | 1. Professionalism | | | | | 2. Communication, patient education and counseling in specialty nursing | | | | | 3. Clinical leadership and resource management in the specialty care setting | | | | | 4. Evidence based and applied research in specialty nursing | | | | +--------------------------------------------------------------------------------------+----------+---------------+--------------+ | II Cardiothoracic Specialty Nursing Courses | | | | | Cardiothoracic Specialty Nursing I | 50 | 10 | | | 1. Context/Introduction to specialty nursing | | | | | 2. Basic sciences applied to specialty care-diagnosis and treatment of clinical | | | | | conditions (Anatomy & Physiology, Microbiology, Pharmacology & Pathophysiology) | | | | | Cardiothoracic Specialty Nursing II | 110 | 30 | 1730 | | 3. Nursing management of clinical conditions including assessment, diagnosis, | | | | | treatment and specialized interventions | | | | | 4. Patient safety and quality | | | | | 5. Specialty/Illness specific considerations (Supportive care/palliative | | | | | care/rehabilitation, Impact of illness on individual, family and community) | | | | +--------------------------------------------------------------------------------------+----------+---------------+--------------+ | TOTAL = 1970 hours | 200 | 40 | 1730 | | | (5 weeks)| (1 week) | (38 weeks) | +--------------------------------------------------------------------------------------+----------+---------------+--------------+ Note: In Specialty Nursing I & II, theory and lab hours may be different in each specialty nursing based on their content and training needs. Total weeks available in a year: 52 weeks ▪ Annual Leave + Casual Leave + Sick Leave + Public Holidays = 6 weeks ▪ Exam preparation and Exam = 2 weeks ▪ Theory and Practical = 44 weeks 2. Implementation of the Curriculum Block classes - 2 weeks × 40 hours per week = 80 hours, Residency - 42 weeks × 45 hours per week = 1890 hours Total: 1970 hours ▪ Block classes (Theory and Skill Lab Experience = 2 weeks × 40 hours per week (80 hours) (Theory = 74 hours, Skill Lab = 6 hours. Total = 80 hours) ▪ Clinical practice including Theory and Skill Lab = 42 weeks × 45 hours per week (1890 hours) (Theory = 126 hours, Skill Lab = 34 hours, Clinical = 1730 hours. Total = 1890 hours) Theory = 200 (74 + 126) hours, Skill Lab = 40 (6 + 34) hours, Clinical = 1730 hours (10% : 90%) 126 hours of theory and 34 hours of skill lab learning can be integrated during clinical experience. Mastery learning and experiential learning approaches are used in training the students throughout the program. Skill Lab Requirements are listed in Appendix 1. 3. Clinical Practice Clinical Residency Experience: A minimum of 45 hours per week is prescribed, however, it is flexible with different shifts and OFF followed by on call duty every week or fortnight. Clinical Placements: The students will be posted to the under mentioned clinical area during their training period. +-------+-----------------------------------+-------------+ | S.No. | Units/Departments | No. of Weeks| +=======+===================================+=============+ | 1. | Cardiothoracic wards | 12 | +-------+-----------------------------------+-------------+ | 2. | OTs (Cardiac and thoracic) | 8 | +-------+-----------------------------------+-------------+ | 3. | Emergency unit | 4 | +-------+-----------------------------------+-------------+ | 4. | Diagnostic labs including Cath lab| 2 | +-------+-----------------------------------+-------------+ | 5. | Cardiothoracic ICU | 12 | +-------+-----------------------------------+-------------+ | 6. | Pediatric Cardiothoracic ICU | 2 | +-------+-----------------------------------+-------------+ | 7. | OPD | 2 | +-------+-----------------------------------+-------------+ | TOTAL | | 42 | +-------+-----------------------------------+-------------+ The residency students will follow the same duty schedule as staff nurses/nursing officers with different shift duties. In addition to that 4 hours every week is dedicated for their learning that can be offered in terms of theory (faculty lecture – 1 hour, nursing & interdisciplinary rounds - 1 hour, clinical presentations, case study report, clinical assignments – 1 hour and skill lab practice - 1 hour) to cover a total of 126 hours of theory and 34 hours of skill lab practice. A small group research project (research/Quality Improvement-QI) can be conducted during clinical posting applying the steps of research process and written report to be submitted. 4. Teaching Methods Theoretical, skill lab & clinical teaching can be done in the following methods and integrated during clinical posting. • Clinical conference • Case/clinical presentation • Case study report • Drug study and presentation • Bedside clinic/Nursing rounds/Interdisciplinary rounds • Clinical seminars • Journal clubs • Faculty lecture and discussion in the clinical area • Demonstration and skill training in skill lab and at bedside • Directed reading/Self study • Role play • Symposium/Group presentation • Group research/QI project • Clinical assignments • Term papers • Workshops • Educational visits Ex. Heart/Lung transplantation unit/Any other Cardiac/thoracic specialty centre Methods of Assessment • Written test • Practical test • Written assignments • Project • Case studies/care plans/clinical presentation • Clinical performance evaluation • Completion of clinical procedural competencies and clinical requirements For Assessment Guidelines refer Appendix 2. 5. Clinical Log Book/Procedures Book At the end of each clinical posting, Clinical Log Book (Specific Procedural Competencies/Clinical Skills) (Appendix 3), Clinical Requirements (Appendix 4) and Clinical Experience Details (Appendix 5) have to be signed by the concerned clinical faculty. FOUNDATIONS TO CARDIOTHORACIC SPECIALTY NURSING PRACTICE: PROFESSIONALISM, COMMUNICATION, PATIENT EDUCATION & COUNSELING, CLINICAL LEADERSHIP & RESOURCE MANAGEMENT AND EVIDENCE BASED AND APPLIED RESEARCH IN CARDIOTHORACIC NURSING PRACTICE Theory: 40 hours Course Description: This course is designed to develop an understanding of professionalism, communication, patient education and counselling, clinical leadership and resource management and evidence based and applied research in cardiothoracic nursing practice. 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| I | 6 | Demonstrate understanding of professionalism and exhibit professionalism in the practice of cardiothoracic nursing | PROFESSIONALISM 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| (hours) | | | | | +---------+---------+---------+---------+--------------------------------------+ | | | | | 1. Short title and commencement | | | | | | | | | | | | i. These Regulations may be called | | | | | | the Indian Nursing Council (Post | | | | | | Basic Diploma in Cardiothoracic | | | | | | Specialty Nursing - Residency | | | | | | Program) Regulations, 2023. | | | | | | 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. | +---------+---------+---------+---------+--------------------------------------+ POST BASIC DIPLOMA IN CARDIOTHORACIC SPECIALTY NURSING – RESIDENCY PROGRAM I. INTRODUCTION The National Health Policy document (NHP, 2017) emphasizes the need to expand tertiary care services, prepare specialist nurses and standardization of clinical training for nurses. Responding to this, the Council planned to redesign the existing specialist nursing programs making it as a one-year post basic diploma residency programs utilizing competency-based training approach. Post Basic Diploma in Cardiothoracic Nursing - Residency Program includes revised guidelines that aim to prepare specialist nurses who can provide competent care to patients with cardiothoracic disorders whose diagnostic, treatment and care needs are complex and intensive. Cardio related problems of the Indians are fast becoming major health problems owing to the rapid change in the life style. It has caused a great concern among the health professionals to meet this challenge. It affects all levels of the people. Since 1983 the NHP has guided the health care system in meeting the needs of the people to a great extent. The policy recognizes the need for establishing the training courses for the super-specialty nurses required for tertiary care institutions. Post Basic Diploma in Cardiothoracic Nursing - Residency Program is designed to prepare specially trained Cardiothoracic Nurses. The outcome of the program will be to have more nurses prepared as cardiothoracic nurses for providing competent nursing care in various health care settings. II. PHILOSOPHY The Council believes that registered nurses need to be trained in cardiothoracic nursing in clinical settings in order to provide competent care to patients with cardiothoracic problems. Expanding roles of nurses and advances in technology necessitates additional training to prepare them for effective participation in cardiothoracic care. III. CURRICULAR FRAMEWORK The Post Basic Diploma in Cardiothoracic Specialty Nursing is a one-year residency program and its curriculum is conceptualized encompassing short foundational courses and major specialty courses for specialty nursing practice. The foundations to cardiothoracic specialty nursing practice such as professionalism, communication, patient education and counselling, clinical leadership and resource management, and evidence based & applied research are short courses that aim to provide the students with the knowledge, attitude and competencies essential to function as accountable, safe and competent specialist nurses. The major specialty courses are organized under Cardiothoracic Specialty Nursing I and Cardiothoracic Specialty Nursing II to include context/introduction to cardiothoracic nursing, basic sciences applied to cardiothoracic nursing (application of basic science knowledge in the diagnosis and treatment of clinical conditions under cardiothoracic specialty nursing), nursing management including assessment, diagnosis, treatment and specialized interventions (in management of specific clinical conditions) and patient safety and quality including specialty/illness considerations. The curricular framework for the residency program is illustrated in the following figure 1. POST BASIC DIPLOMA IN CARDIOTHORACIC SPECIALTY NURSING – RESIDENCY PROGRAM Foundations to Cardiothoracic Nursing Courses Cardiothoracic Specialty Nursing Courses +-----------------------------+------------------------------------------------+--------------------------------------+ | Professionalism | COURSES Context/Introduction to specialty | Basic sciences applied to specialty | | | nursing practice | care | +-----------------------------+------------------------------------------------+--------------------------------------+ | Communication, patient | | Nursing Management incl. assessment | | education & counseling | | and specialized interventions | +-----------------------------+------------------------------------------------+--------------------------------------+ | Clinical leadership and | | | | resource management | Cardiothoracic Specialty Nursing education for | Patient safety & quality, and Illness| | | Specialist Practice | specific considerations | +-----------------------------+------------------------------------------------+--------------------------------------+ | Evidence based and applied | | | | research | | | +-----------------------------+------------------------------------------------+--------------------------------------+ ONE-YEAR RESIDENCY PROGRAM (For Registered Nurses & Midwives) Theory – 10% & Practicum – 90% (Skill Lab + Clinical) Figure 1. Curricular Framework for Cardiothoracic Specialty Nursing – Residency Program IV. AIM/PURPOSE & COMPETENCIES Aim The program is designed to prepare nurses with specialized skills, knowledge and attitude in providing quality care to patients with cardiothoracic disorders. It further aims to prepare technically qualified and trained specialist nurses who will function effectively and optimally at cardiothoracic centres of tertiary/quaternary hospitals providing high standards of care. Competencies On completion of the program, the cardiothoracic specialist nurse will be able to: 1. Demonstrate professional accountability for the delivery of nursing care as per the Council standards that is consistent with moral, altruistic, legal, ethical, regulatory and humanistic principles in cardiothoracic practice. 2. Communicate effectively with patients, families and professional colleagues fostering mutual respect and shared decision making to enhance health outcomes. 3. Educate and counsel patients and families to participate effectively in treatment and care and enhance their coping abilities through crisis and bereavement. 4. Demonstrate understanding of clinical leadership and resource management strategies and use them in cardiothoracic care and settings promoting collaborative and effective teamwork. 5. Identify, evaluate and use the best current evidence in cardiothoracic care and treatment coupled with clinical expertise and consideration of patient's preferences, experience and values to make practical decisions in cardiothoracic nursing practice. 6. Participate in research studies that contribute to evidence-based cardiothoracic nursing care interventions with basic understanding of research process 7. Apply basic sciences in the assessment, diagnosis and treatment of the physiological, physical, psychological, social and spiritual problems of patients and their families with cardiothoracic disorders. 8. Describe the concepts and principles of cardiothoracic nursing. 9. Demonstrate skills in advanced cardiac life support. 10. Apply nursing process in caring for patients with cardiothoracic disorders. 11. Communicate effectively with patients having cardiothoracic problems and their family members. 12. Demonstrate skills in management of cardiothoracic services/units. 13. Participate effectively as a member of the cardiac care team. 14. Make a plan for organization of cardiac and thoracic units. 15. Provide end of life care promoting comfort and dignity respecting individual cultural and spiritual needs and differences. 16. Teach and supervise nurses and allied health workers. V. PROGRAM DESCRIPTION AND SCOPE OF PRACTICE The Post Basic Diploma in Cardiothoracic Specialty Nursing – Residency Program is designed to prepare registered nurses (GNM or B.Sc.) with specialized knowledge, skills and attitude in providing advance quality care to patients with cardiothoracic disorders and their families. Emphasis is laid on clinical competency with relevant theory. The theory component comprises 10% and practicum 90% (Clinical & Lab). On completion of the program and certification, and registration as additional qualification with respective SNRC, the cardiothoracic specialist nurses should be employed only in cardiothoracic unit of a multi-specialty hospital. They will be able to practice as per the competencies trained during the program particularly the specialized procedural competencies/clinical skills as per the log book of the Council syllabus. The specialist nurses can be privileged to practice those specialized procedural competencies by the respective institution as per institution protocols. Specialist nurse cadres/positions should be created at government/public/private sectors. The diploma will be awarded by respective Examination Board/SNRC/University approved by the Council. VI. MINIMUM REQUIREMENTS/GUIDELINES FOR STARTING THE POST BASIC DIPLOMA IN CARDIOTHORACIC SPECIALTYT NURSING-RESIDENCY PROGRAM The program may be offered at 1. College of Nursing offering degree programs in nursing attached to parent hospital having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art cardiothoracic units with optimum monitoring and life support equipment/facilities required to provide effective care to patients with cardiothoracic disorders and specialized nursing care facilities. OR Hospitals offering DNB/Fellowship programs in cardiothoracic surgery having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art cardiac and thoracic care units/CT intensive care units with optimum monitoring and life support equipment/facilities required to provide effective care to patients with cardiothoracic conditions and specialized nursing care facilities. 2. The above eligible institution shall get recognition from the concerned SNRC for Post Basic Diploma in Cardiothoracic Specialty Nursing for the particular academic year, which is a mandatory requirement. 3. The Council shall after receipt of the above documents/proposal would then conduct statutory inspection of the recognized training nursing institution under Section 13 of the Act in order to assess the suitability with regard to availability of teaching faculty, clinical and infrastructural facilities in conformity with Regulations framed under the provisions of the Act. 1. Teaching Faculty a. Full time teaching faculty in the ratio of 1:10. b. Minimum number of faculty should be two. c. Qualification and Number: i. M.Sc. Nursing with Medical Surgical Nursing/Cardiothoracic Specialty Nursing - 1 ii. Post Basic Diploma in Cardiothoracic Specialty Nursing with Basic B.Sc. Nursing/P.B.B.Sc. Nursing - 1 d. Experience: Minimum three years of clinical experience in Cardiothoracic Specialty Nursing. e. Guest Faculty: Multi-disciplinary in related specialities. f. Preceptors: • Nursing Preceptor: Full time qualified GNM with six years of experience in Cardiothoracic Specialty Nursing or B.Sc. Nursing with two years of experience in Cardiothoracic Specialty Nursing or M.Sc. Nursing with one year of Cardiothoracic Specialty Nursing experience working in any of the cardiothoracic units/ICUs. • Medical Preceptor: Specialist doctor with PG qualification (with 3 years' post PG experience/faculty level/consultant level preferable). • Preceptor Student Ratio: Nursing 1:10, Medical 1:10 (Every student must have a medical and nursing preceptor) 2. Budget There should be budgetary provision for staff salary, honorariums for guest faculty, and part time teachers, clerical assistance, library and contingency expenditure for the program in the overall budget of the institution. 3. Physical and Learning Resources at Hospital/College a. One classroom/conference room at the clinical area b. Skill lab for simulated learning at hospital/college. Skill Lab Requirements are listed in Appendix-1. c. Library and computer facilities with access to online journals: i. College library having current books, journals and periodicals related to Cardiothoracic Specialty Nursing, anatomy & physiology, microbiology, pharmacology, pathophysiology, Nursing Administration, Nursing Education, Nursing Research and Statistics. OR Permission to use medical college/hospital library having current books, journals and periodicals related to Cardiothoracic Specialty Nursing, anatomy & physiology, microbiology, pharmacology, pathophysiology, Nursing Administration, Nursing Education, Nursing Research and Statistics. ii. Computer with internet facility. d. E-Learning facilities e. Teaching Aids - Facilities for use of: i. Overhead Projectors ii. Video viewing facility iii. LCD Projector iv. CDs, DVDs and DVD players v. Appropriate equipment, manikins and simulators for skill learning f. Office facilities: i. Services of typist, peon, Safai Karmachari ii. Facilities for office, equipment and supplies such as • Stationery • Computer with printer • Xerox machine • Telephone and Fax 4. Clinical Facilities a. Parent specialty hospital/tertiary hospital having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art cardiothoracic unit/intensive care units with optimum monitoring and life support equipment/facilities required to provide effective care to patients with cardiothoracic disorders and specialized nursing care facilities. b. Hospital must have a minimum of 20 specialty beds including cardiothoracic ICU (Minimum of 10 ICU beds) with advanced diagnostic, treatment and care facilities. c. Regional centres/cardiothoracic specialty hospitals having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art cardiothoracic unit/intensive care units with optimum monitoring and life support equipment/facilities required to provide effective care to patients with cardiothoracic disorders and specialized nursing care facilities. d. Nurse staffing of units as per the Council recommended norms. e. Student patient ratio: 1:1-2. 5. Admission Terms and Conditions/Entry Requirements The student seeking admission to this program should: a. Be a registered nurse (RN & RM) or equivalent with any SNRC having NUID number. b. Possess a minimum of one-year clinical experience as a staff nurse preferably in the cardiothoracic unit prior to enrolment. c. Be physically fit. d. Selection must be based on the merit obtained in an entrance examination and interview held by the competent authority. e. Nurses from other countries must obtain an equivalence certificate from the Council before admission. 6. Number of Seats For hospital having 200 beds and 20 specialty beds, number of seats = 10-20, For hospital having 500 beds and more with 30 specialty beds, the number of seats = 15-30. 7. Number of Candidates 1 candidate for 1-2 specialty beds. 8. Salary a. In-service candidates will get regular salary. b. Stipend/Salary for the other candidates as per the salary structure of the hospital where the program is conducted. VII. EXAMINATION REGULATIONS AND CERTIFICATION EXAMINATION REGULATIONS Examining and Diploma Awarding Authority: Respective Examination Board/SNRC/University approved by the Council. 1. Eligibility for appearing for the Examination a. Attendance: Theory & Practical - 80%. However, 100% Clinical attendance have to be completed prior to certification. b. Candidate who successfully completes the necessary requirements such as log book and clinical requirements is eligible and can appear for final examination. 2. Practical Examination a. OSCE: Objective Structured Clinical Examination (OSCE) type of examination will be conducted alongside viva (oral examination) both in the internal and final examination. (Detailed guidelines are given in guidebook.) b. Observed Practical/Clinical: Final internal and external examination will also include assessment of actual clinical performance in real settings including viva and mini clinical evaluation exercise for 3-4 hours (Nursing process application and direct observation of procedural competencies). Minimum period of assessment in the clinical area is 5-6 hours. (Evaluation guidelines are given in guidebook.) c. Maximum number of students per day = 10 students d. Practical Examination should be held in clinical area only e. The team of practical examiners will include one internal examiner [(M.Sc. faculty with two years of experience in teaching the respective specialty program/M.Sc. faculty (Medical Surgical Nursing) with 5 years of Post PG experience], one external examiner (nursing faculty with the same qualification and experience stated as above) and one medical internal examiner who should be preceptor for specialty program. f. The practical examiner and the theory examiner should be the same nursing faculty or from the same specialty. 3. Standard of Passing a. In order to pass, a candidate should obtain at least 60% marks in aggregate of internal assessment and external examination both together, in each of the theory and practical papers. Less than 60 % is considered fail. b. Students will be given opportunity of maximum of 3 attempts for passing. c. If the student fails in either theory or practical, he/she needs to appear for the exam failed either theory or practical only. CERTIFICATION a. TITLE: Post Basic Diploma in Cardiothoracic Specialty Nursing b. A diploma is awarded by Examination Board/SNRC/University approved by the Council, upon successful completion of the prescribed study program, which will state that i. Candidate has completed all the courses of study under the Post Basic Diploma in Cardiothoracic Specialty Nursing - Residency Program ii. Candidate has completed 80% theory and 100% clinical requirements iii. Candidate has passed the prescribed examination. VIII. SCHEME OF EXAMINATION +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ | Courses | Internal Assessment Marks | External Assessment Marks | Total Marks | Exam Hours | +================================================+============================+============================+=============+============+ | A. Theory (Experiential/Residential Learning) | | | | | +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ | Cardiothoracic Specialty Nursing | 25 | 75 | 100 | 3 | | (Part I & Part II) | (10+15) | (35+40) | | | | {Part I - Cardiothoracic Specialty Nursing I | | | | | | including Foundations to Cardiothoracic | | | | | | Specialty Nursing practice, Part II – | | | | | | Cardiothoracic Specialty Nursing II} | | | | | +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ | B. Practicum (Cardiothoracic Specialty Nursing) | 75 | 150 | 225 | Minimum | | • OSCE including Viva | (25+50) | (50+100) | | 5-6 hours | | • Observed Practical/Clinical (Direct | (OSCE-25 & | (OSCE-50 & | | in the | | observation of actual performance at real | Observed Practical-50) | Observed Practical-100) | | clinical | | settings) including viva - mini clinical | | | | area | | evaluation exercise for 3-4 hours (Nursing | | | | | | process application and direct observation | | | | | | of procedural competencies) | | | | | +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ | Grand Total | 100 | 225 | 325 | | +------------------------------------------------+----------------------------+----------------------------+-------------+------------+ Detailed guidelines given in Guidebook. IX. PROGRAM ORGANIZATION/STRUCTURE 1. Courses of Instruction 2. Implementation of Curriculum 3. Clinical Practice (Residency Posting) 4. Teaching Methods 5. Methods of Assessment 6. Log Book & Clinical Requirements 1. Courses of Instruction 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