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

REGD. No. D. L.-33004/99 The Gazette of India सी.जी. डी.एल.-अ.-27012025-260514 CG-DL-E-27012025-260514 EXTRAORDINARY PART III-Section 4 PUBLISHED BY AUTHORITY No. 51] NEW DELHI, FRIDAY, JANUARY 17, 2025/PAUSHA 27, 1946 INDIAN NURSING COUNCIL NOTIFICATION New Delhi, the 26th December, 2024 INDIAN NURSING COUNCIL {NURSE PRACTITIONER IN NEPHROLOGY NURSING (NPNepN) - POSTGRADUATE RESIDENCY PROGRAM} REGULATIONS, 2024 F.No. 11-1/2024-INC (X):—In exercise of the powers conferred by sub-section (1) of Section 16 of Indian Nursing Council Act, 1947 (XLVIII of 1947), as amended from time to time, the Indian Nursing Council hereby makes the following regulations, namely:— 1. SHORT TITLE AND COMMENCEMENT i. These Regulations may be called the Indian Nursing Council {Nurse Practitioner in Nephrology Nursing (NPNepN) - Postgraduate Residency Program} Regulations, 2024. ii. These shall come into force on the date of notification of the same in the Official Gazette of India. 2. DEFINITIONS In these Regulations, unless the context otherwise requires, i. 'the Act' means the Indian Nursing Council Act, 1947 (XLVIII of 1947) as amended from time to time; ii. 'the Council' means the Indian Nursing Council constituted under the Act; iii. 'SNRC' means the State Nurse and Midwives Registration Council, by whichever name constituted, by the respective State Governments; iv. 'RN & RM' means a Registered Nurse and Registered Midwife (RN & RM) and denotes a nurse who has completed successfully, recognised Bachelor of Nursing (B.Sc. Nursing) or Diploma in General Nursing and Midwifery (GNM) course, as prescribed by the Council and is registered in a SNRC as Registered Nurse and Registered Midwife; v. 'Nurses Registration & Tracking System (NRTS)' means a system developed by the Council and software developed in association with National Informatics Centre (NIC), Government of India, and hosted by NIC for the purpose of maintenance and operation of the Indian Nurses Register. It has standardised forms for collection of the data of Registered Nurse and Registered Midwife (RN & RM)/Registered Auxiliary Nurse Midwife (RANM)/Registered Lady Health Visitor (RLHV) upon Aadhar based biometric authentication; vi. 'NUID' is the Nurses Unique Identification Number given to the registrants in the NRTS system; vii. 'General Nursing and Midwifery (GNM)' means Diploma in General Nursing and Midwifery qualification recognized by the Council under Section 10 of the Act and included in Part-I of the Schedule of the Act. THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] NURSE PRACTITIONER IN NEPHROLOGY NURSING (NPNepN) - POSTGRADUATE RESIDENCY PROGRAM I. Introduction and Background In India, reshaping health systems in all dimensions of health has been recognized as an important need in the National Health Policy, 2017 (NHP 2017). It emphasizes human resource development in the areas of education and training alongside regulation and legislation. The government recognizes significant expansion in tertiary care services both in public and private health sectors. In building their capacity, it is highly significant that the healthcare professionals require advanced educational preparation in specialty and super-specialty services. To support specialized and super-specialized healthcare services, specialist nurses with advanced preparation are essential. Developing training programs and curriculum in the area of tertiary care is recognized as the need of the hour. Nurse Practitioners (NPs) will be able to meet this demand provided they are well trained and empowered to practice. With establishment of new cadres in the Center and State level, master level prepared Nurse Practitioners will be able to provide cost effective, competent, safe and quality driven specialized nursing care to patients in a variety of critical care settings in tertiary care centers. Nurse practitioners have been prepared and functioning in USA and Canada since 1960s, UK since 1980s, Australia since 1990s and Netherlands since 2010. Nurse practitioners in critical care/acute care, oncology, nephrology care, emergency care, neuro care, cardiovascular care, anesthesia care and other specialties can be prepared to function in secondary and tertiary care settings. A curricular structure/framework is proposed by the Council towards preparation of Nurse Practitioner in Nephrology Nursing (NPNepN) at Masters' Level. The special feature of this program is that it is a clinical residency program emphasizing a strong clinical component with 15% of theoretical instruction and 85% of practicum. THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] An educational framework for the NP curriculum is proposed (See Figure 1) Strong Clinical Component (Clinical Residency) Theory-15% I. Core Courses • Theoretical Basis for Advanced Nursing Practice • Research Application and Evidence Based Practice in Nephrology Nursing • Advance Skills in Leadership, Management and Teaching • Foundations of Nephrology Nursing Practice • Nephrology Nursing I • Nephrology Nursing II Nurse Practitioner in Nephrology Nursing (NPNepN) • Advanced Pathophysiology applied to Nephrology Nursing • Advanced Pharmacology applied to Nephrology Nursing • Advanced Health/ • Physical Assessment II. Advanced Practice Courses BTOONS III ecialty Courses Competency Based Education and Training Practicum - 85% Advanced Knowledge and Ethics Registered B.Sc./P.B.B.Sc. Nurse with 1-year Clinical Experience in Medical Surgical Nursing/Pediatric Nursing (Entry requirement) Figure 1. Nurse Practitioner in Nephrology Nursing (NPNepN) - An Educational Curricular Framework THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] II. Program Description The Nurse Practitioner in Nephrology Nursing (NPNepN) program is a residency nursing program with a main focus on competency based training. The duration is of two years with the curriculum consisting of theory that includes core courses, advanced practice courses and clinical courses besides clinical practicum which is a major component (Refer Curricular framework). This program is designed to assist the NP studens in developing expertise and in depth understanding in the field of nephrology nursing. It will help them to develop advanced skills for nursing interventions while taking care of patients with kidney diseases. III. Aim The NPNepN program prepares registered B.Sc. nurses for advanced practice roles as clinical experts, managers, educators and consultants leading to M.Sc. degree (Nurse Practitioner in Nephrology Nursing). IV. Objectives On completion of the program, the NPNepN will be able to - 1. assume responsibility and accountability to provide competent family centered care to patients with kidney diseases in various healthcare settings. THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 2. demonstrate clinical competence including expertise in clinical assessment of patients with varied kidney disorders, education, diagnostic reasoning, complex monitoring, and therapies including diet and liaising with resource agencies. 3. apply clinical knowledge, scientific principles, critical thinking skills and evidence base to implementing therapies/interventions in nephrology nursing. 4. participate in treating patients with kidney diseases to stabilize and restore patient's health and minimize or manage complications independently or collaboratively as a part of Nephrology team 5. collaborate with other healthcare professionals in the nephrology team, across the continuum of care. V. Minimum requirements to start the Nurse Practitioner in Nephrology Nursing (NPNepN) program The institution must accept the accountability for the NPNepN program and its students and offer the program congruent with the Council standards. It must fulfill the following requirements - 1. Essentiality Certificate a. Any institution who wishes to start Nurse Practitioner in Nephrology Nursing (NPNepN) program shall obtain an Essentiality Certificate/Government Order from the State. b. The following institutions are exempted from obtaining Essentiality Certificate - i. Institutions/Universities already offering B.Sc. Nursing or M.Sc. Nursing programs and found suitable by the Council under Sections 13 and 14 of the Act; ii. Institutions/Universities offering MBBS/DNB programs. 2. Hospital a. The institute should have a parent hospital/tertiary care centre with a minimum of 200 beds. b. It is preferable to have a medical college/nursing college attached to the parent hospital. 3. Nephrology Beds The hospital should have at least one nephrology ward with minimum of 20 beds, a hemodialysis unit with minimum 10 beds and scope for kidney transplant services. It is preferable to have a peritoneal dialysis unit with a minimum of 2 beds. 4. Nephrology Unit Staffing a. The ward and dialysis unit should have a Charge Nurse preferably with B.Sc. Nursing or M.Sc. Nursing qualification. b. The nurse patient ratio should be 1:6 for every shift in the general ward. c. For the dialysis unit, the nurse patient ratio should be 1:1 for every shift. d. Provision of additional 45% staff towards leave reserve. 5. Faculty/Staff Resources a. Clinical area: i. Nursing Preceptor - Full-time qualified GNM with 6 years of experience in nephrology nursing (preferably with Post Basic Diploma in Renal Nursing) or B.Sc. Nursing with 2 years of experience in Nephrology Nursing or M.Sc. (Specialty-Medical Surgical Nursing) with one year experience in Nephrology Nursing ii. Medical Preceptor - DM in Nephrology iii. Preceptor student ratio - Nursing 1:10, Medical 1:10 (Every student must have a medical and nursing preceptor) b. Teaching faculty: i. Professor/Associate professor - 1 {Teaching experience: 5 years post PG - M.Sc. (Specialty - Medical Surgical Nursing)} with faculty student ratio of 1:10 ii. Assistant professor - 1 (Teaching experience: 3 years post B.Sc.) iii. The above faculty shall perform dual role or be a senior nurse with M.Sc. Nursing qualification employed in nephrology unit iv. Guest Lecturers for Pharmacology and Pathophysiology 6. Physical and learning resources at hospital/college a. One classroom/conference room at the clinical area b. Skill Lab for simulated learning (hospital/college) c. Library and computer facilities with access to online journals d. E-Learning facilities 7. List of equipment (enclosed in Appendix 1). 8. Student Recruitment/Admission Requirements a. Applicants must be a registered B.Sc./P.B.B.Sc. nurse with a minimum of one year clinical experience, preferably in any Nephrology care setting prior to enrollment. b. Must have undergone the B.Sc./P.B.B.Sc. in an institution recognized by the Council and should be enrolled in the respective SNRC. c. Must have scored not less than 55% aggregate marks in the B.Sc. nursing program. THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] d. Selection must be based on the merit of an entrance examination and interview held by the competent authority. e. Must be physically fit. Number of candidates - 1 candidate for 3 dialysis beds and 5 in-patients in nephrology unit. Salary 1. In-service candidates will get regular salary. 2. Stipend/Salary for the other candidates as per the salary structure of the hospital where the course is conducted. VI. Examination Regulations Eligibility for appearing for the Examination Attendance: Minimum 80% for theory and practical before appearing for final University examination but must complete 100% in practical before the award of degree. There is no minimum cut off for internal assessment marks, as internal and external marks are added together for declaring pass. Examining and Degree Awarding Authority: Respective University Declaration of Results The candidate is declared to have passed the exam if the score is 60% and above. This score is the aggregate of both internal and external University examination in theory and practical in every course/subject and less than 60% is fail. For calculating the rank, the aggregate of the two years' marks will be considered. If a candidate fails in theory or practical, he/she must appear for the paper in which he/she has failed. Rank will not be declared for candidates who fail in any subject. Maximum period to complete the program is 4 years. Practical examination OSCE type of examination is to be conducted alongside viva (oral examination) - Refer OSCE Guidelines found in Appendix 2. Maximum number of students for practical exam per day will be 10 students. Examination should be held in clinical area only. The team of practical examiners will include one internal examiner {(M.Sc. Nursing faculty with two years of experience in teaching the NPNepN program/M.Sc. Nursing faculty (Medical Surgical Nursing) with 5 years of post PG experience}, one external examiner (same as above) and one medical internal examiner who should be the preceptor for NPNepN program. Dissertation* Research Guides: Main guide: Nursing faculty (3 years Post PG experience) teaching NPNepN program, Co-guide: Medical preceptor Submission of Research Proposal: 6-9 months after date of admission in the first year Guide Student Ratio: 1:5 Research Committee: There shall be a separate research committee in the college/hospital to guide and oversee the progress of the research (minimum of 5 members with Principal or CNO who is M.Sc. Nursing qualified). Ethical Clearance must be obtained by the Institutional Review Board/Hospital Ethics Committee since it involves clinical research. Topic Selection: The topic should be relevant to Nephrology Nursing that will add knowledge or evidence for nursing intervention. The research should be conducted in any of the Nephrology care settings. Data Collection: 7 weeks are allotted for data collection, which can be integrated during clinical experience after 6 months in first year and before 6 months in second year. Writing the Research Report: 6-9 months in second year. Submission of Dissertation Final: 3 months before completion of the second year. Dissertation Examination Internal Assessment: Viva & Dissertation Report = 50 marks. University Examination: Viva & Dissertation Report = 50 marks. (Marking guide used for other M.Sc. Nursing specialties can be used for evaluation.) *EBP project may be conducted in place of dissertation and report submitted for evaluation. VII. Assessment (Formative and Summative) • Quiz • Seminar • Written assignments THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • Case/Clinical presentation • Clinical or care pathway/Case study report • Clinical performance appraisal • Log Book: Procedural competency and completion of clinical requirements signed by the medical/nursing faculty/preceptor • Objective Structured Clinical Examination (OSCE) • Test papers, Quiz • Final examination (Refer Appendix 2 for Assessment Guidelines) Scheme of Final Examination +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |S.No. |Title |Theory % | Practical %| | | | | | | |Hours |Internal |External |Hours |Internal |External | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |Ist year | | | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |Core Courses | | | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |1 |Theoretical Basis for Advanced Practice Nursing |2 |50 | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |2 |Research Application and Evidence Based Practice |3 |30 |70 | | | | | |in Nephrology Nursing | | | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |3 |Advanced Skills in Leadership, Management and |3 |30 |70 | | | | | |Teaching | | | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |Advanced Practice Courses | | | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |4 |Advanced Pathophysiology & Advanced |3 |30 |70 | | | | | |Pharmacology applied to Nephrology Nursing | | | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |5 |Advanced Health/Physical Assessment |3 |30 |70 |50 |50 | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |IInd year | | | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |Specialty Courses | | | | | | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |1 |Foundations of Nephrology Nursing Practice |3 |30 |70 |100 |100 | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |2 |Nephrology Nursing I |3 |30 |70 |100 |100 | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |3 |Nephrology Nursing II |3 |30 |70 |100 |100 | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ |4 |Dissertation and viva | | | |50 |50 | | +------+-------------------------------------------------+-------+----------+----------+-------+----------+----------+ VIII. Courses of Instruction +------+-------------------------------------------------+-----------+-------------+---------+ |S.No. |Title |Theory |Lab/Skill Lab|Clinical | | | |(hours) |(hours) |(hours) | +------+-------------------------------------------------+-----------+-------------+---------+ |Ist year | | | | +------+-------------------------------------------------+-----------+-------------+---------+ |Core Courses | | | | +------+-------------------------------------------------+-----------+-------------+---------+ |I |Theoretical Basis for Advanced Practice Nursing |40 | | | +------+-------------------------------------------------+-----------+-------------+---------+ |II |Research Application and Evidence Based Practice |56 |24 |336 (7 weeks)| | |in Nephrology Nursing | | | | +------+-------------------------------------------------+-----------+-------------+---------+ |III |Advanced Skills in Leadership, Management and |56 |24 |192 (4 weeks)| | |Teaching | | | | +------+-------------------------------------------------+-----------+-------------+---------+ |Advanced Practice Courses | | | | +------+-------------------------------------------------+-----------+-------------+---------+ |IV |Advanced Pathophysiology applied to Nephrology Nursing|60 | |336 (7 weeks)| +------+-------------------------------------------------+-----------+-------------+---------+ |V |Advanced Pharmacology applied to Nephrology Nursing|54 | |336 (7 weeks)| +------+-------------------------------------------------+-----------+-------------+---------+ |VI |Advanced Health/Physical Assessment |70 |48 |576 (12 weeks)| +------+-------------------------------------------------+-----------+-------------+---------+ |TOTAL |336 (7 weeks)|96 (2 weeks) |1776 (37 weeks)| +------+-------------------------------------------------+-----------+-------------+---------+ |IInd year | | | | +------+-------------------------------------------------+-----------+-------------+---------+ |Specialty Courses | | | | +------+-------------------------------------------------+-----------+-------------+---------+ |VII |Foundations of Nephrology Nursing Practice |96 |48 |576 (12 weeks)| +------+-------------------------------------------------+-----------+-------------+---------+ |VIII |Nephrology Nursing I |96 |48 |576 (12 weeks)| +------+-------------------------------------------------+-----------+-------------+---------+ |IX |Nephrology Nursing II |96 |48 |624 (13 weeks)| +------+-------------------------------------------------+-----------+-------------+---------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] TOTAL = 2208 hours 288 (6 weeks) 144 (3 weeks) 1776 (37 weeks) Number of weeks available in a year = 52 - 6 (Annual leave, Casual leave, Sick leave = 6 weeks) = 46 weeks × 48 hours = 2208 hours Two years = 4416 hours (Examination during clinical posting) Instructional hours: Theory = 624 hours, Skill Lab = 240 hours, Clinical = 3552 hours TOTAL = 4416 hours Ist year: 336-96-1776 hours (Theory-Practicum) [Theory = 15%, Practicum = 85%] IInd year: 288-144-1776 hours (Theory-Practicum) [Theory = 15%, Practicum = 85%] Ist year = 46 weeks/2208 hours (46×48 hours) (Theory + Lab: 7.5 hours per week for 44 weeks = 330/336+96 hours*) *Theory + Lab = 96 hours can be given for 2 weeks in the form of introductory block classes and workshops IInd year = 46 weeks/2208 hours (46×48 hours) (Theory + Lab: 8.5 hours per week for 45 weeks = 384+48 hours) (1 week Block Classes = 48 hours) CLINICAL PRACTICE A. Clinical Residency Experience (A minimum of 48 hours per week is prescribed, however, it is flexible with different shifts and OFF followed by ON CALL duty) B. 8 hours duty with one day OFF in a week and ON CALL duty once per week. Clinical Placements Ist year: 44 weeks (excludes 2 weeks of introductory block classes and workshop) • Adult Nephrology ward - 10 weeks • Pediatric Nephrology ward - 4 weeks • Dialysis Unit - 14 weeks • Urology ward - 2 weeks • Renal Transplant Unit - 5 weeks • Nephrology OPD - 4 weeks (including transplant OPD) • Medical ICU - 4 weeks • Organ Donation Unit/NOTO - 1 week IInd year: 45 weeks (excludes one week of block classes) • Medical ICU - 4 weeks • Surgical ICU - 2 weeks • Pediatric ICU - 2 weeks • Adult Nephrology Ward - 8 weeks • Pediatric Nephrology Ward - 2 weeks • Nephrology OPD - 6 weeks • Dialysis Unit - 10 weeks (including Peritoneal Dialysis-PD) • Kidney Transplant Unit - 5 weeks • Operation Theatre - 4 weeks • Urology ward - 2 weeks C. Teaching/Learning methods Learning will be faculty facilitated self-directed, integrated with clinical experience. • Experiential learning • Reflective learning • Simulation based learning • Clinical conference • Case/clinical presentation • In depth drug study, presentation and report • Nursing rounds • E-learning, narrated presentations • Flipped classroom • Clinical seminars • Journal clubs THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • Case study/Clinical or care pathway • Advanced health assessment • Faculty lecture in the clinical area • Directed reading • Demonstrations, supervised skill practice • Assignments • Case study analysis • Workshops • Observation of procedures • Demonstration and supervised skill practice D. Procedures/Log Book At the end of each Clinical Posting, Clinical Log Book (Specific Procedural Competencies/Clinical Skills) (Appendix 3) and Clinical Requirements (Appendix 4) have to be signed by the preceptor/faculty every fortnight. E. Nurse Practitioner in Nephrology Nursing Competencies (Adapted from ICN, 2020) 1. Uses advanced comprehensive assessment, diagnosis, treatment planning, implementation, and evaluation skills. 2. Applies and adapts advanced skills in complex and/or unstable environments. 3. Applies sound advanced clinical reasoning and decision making to inform, guide and teach in practice. 4. Documents assessment, diagnosis, management and monitors treatment and follow-up care in partnership with the patient. 5. Administer drugs and treatments according to institutional protocols. 6. Uses applicable communication, counseling, advocacy and interpersonal skills to initiate, develop and discontinue therapeutic relationships. 7. Refers to and accepts referrals from other healthcare professionals to maintain continuity of care. 8. Practices independently where authorized and the regulatory framework allows in the interest of the patients, families and communities. 9. Consults with and is consulted by other healthcare professionals and others. 10. Works in collaboration with health team members in the interest of the patient. 11. Develops a practice that is based on current scientific evidence and incorporated into the health management of patients, families and communities. 12. Initiates, evaluates and manages evidence based practice. 13. Uses research to produce evidence based practice to improve the safety, efficiency and effectiveness of care through independent and inter-professional research. 14. Engages in ethical practice in all aspects of the APN role and responsibility. 15. Accepts accountability and responsibility for own advanced professional judgement, actions, and continued competence. 16. Creates and maintains a safe therapeutic environment through the use of risk management strategies and quality improvement. 17. Assumes leadership and management responsibilities in the delivery of efficient advanced practice nursing services in a changing healthcare system. 18. Acts as an advocate for patients in the healthcare systems and the development of health policies that promote and protect the individual patient, family and community. 19. Adapts practice to the contextual and cultural milieu. Core Competencies of ANNA (2020) 1. Advanced knowledge in nephrology that includes pathophysiology and management of kidney/urologic conditions and their complications. 2. Excellent interpersonal, communication, and critical thinking skills. 3. Advanced clinical skills in assessment, diagnosis and management of patients with kidney disorders that include kidney replacement therapy. 4. Sensitivity to the needs of patients and their families as they deal with kidney diseases and its impact. 5. Ability to teach patients about kidney diseases, treatment, and life style changes. 6. Ability to deal with grief and loss that can be associated with kidney disease. 7. Ability to work in a multidisciplinary team in care coordination. THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] F. Institutional Protocol/Standing Orders based administration of drugs & ordering of investigations and therapies The students will be trained to independently administer drugs and order diagnostic tests, procedures, medical equipment and therapies as per institutional protocols/standing orders (Appendix 5 Standing Orders). Administration of emergency drugs is carried out in consultation with concerned physician and endorsed later by written orders. Implementation of Curriculum - A Tentative Plan +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ |Ist year Courses |Introductory Classes|Workshop |Theory integrated |Methods of Teaching | | | | |into Clinical | (Topic can be specified) | | | | |Practicum | | +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ |1. |Theoretical Basis for Advanced Practice Nursing |8 hours | |1×32 = 32 hours |• Seminar/Theory Application | | |(40) | | | |• Lecture (Faculty) | | | | | | |• Journal Presentation | | | | | | |• Flipped Classroom | +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ |2. |Research Application and Evidence Based Practice |8 hours |40 (5 days) |1×24 = 24 hours |• Research Study Analysis | | |in Nephrology Nursing (56+24) | |+ 8 hours | |• Exercise/Assignment (Lab) | +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ |3. |Advanced Skills in Leadership, Management and |4 hours |16 hours |1×26 = 26 hours |• Clinical Conference | | |Teaching (56+24) | |(2 days) |2×16 = 32 hours |• Seminar, Practice Teaching | | | | | | |• Workshop | | | | | | |• Exercises/Assignment (Lab) | +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ |4. |Advanced Pathophysiology | | |1.5×40 = 60 hours |• Case Presentation | | |applied to Nephrology | | | |• Seminar | | |Nursing (60) | | | |• Clinical Conference | | | | | | |• Concept Mapping | +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ |5. |Advanced Pharmacology |10 hours | |1×44 = 44 hours |• Nursing Rounds | | |applied to Nephrology | | | |• Drug Study Presentation | | |Nursing (54) | | | |• Standing Orders | | | | | | |• Lecture/Discussions | | | | | | |• Drug Diary | +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ |6. |Advanced Health/ Physical |8 hours | |2×26 = 52 hours |• Clinical Demonstration | | |Assessment (70+48) | | |1.5×18 = 27 hours |(Faculty) | | | | | |1×15 = 15 hours |• Return Demonstration | | | | | |2×6 = 12 hours |• Nursing Rounds | | | | | |2×2 = 4 hours |• Physical Assessment (all | | | | | | | systems) | | | | | | |• Case Study | +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ |TOTAL | |48 hours |48 hours |336 hours | | +------+-------------------------------------------------+-------------------+--------------+----------------------------+-----------------------------------------+ Ist year - Introductory classes = 1 week (48 hours), Workshop = 1 week (48 hours), 44 weeks = 7.5 hours per week (330/336 hours) +------+-------------------------------------------------+----------------------------+-----------------------------------------+ |IInd year Courses |Theory and Skill Lab integrated |Methods of Teaching | |1 week Block Classes (48 hours) |into Clinical Practicum | | +------+-------------------------------------------------+----------------------------+-----------------------------------------+ |1. |Foundations of Nephrology |9×16 = 144 hours |• Demonstration | | |Nursing Practice | |• Supervised Practice | | |(96+48 hours) = 144 hours | |• Clinical Teaching | | | | |• Case Study | | | | |• Seminar | | | | |• Clinical Conference | | | | |• Faculty Lecture | +------+-------------------------------------------------+----------------------------+-----------------------------------------+ |2. |Nephrology Nursing I |9×16 = 144 hours |• Demonstration | | |(96+48 hours) = 144 hours | |• Supervised Practice | | | | |• Clinical Conference/Journal Club | | | | |• Flipped Classroom | | | | |• Seminar | +------+-------------------------------------------------+----------------------------+-----------------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] |IInd year Courses |Theory and Skill Lab integrated |Methods of Teaching | |1 week Block Classes (48 hours) |into Clinical Practicum | | +------+-------------------------------------------------+----------------------------+-----------------------------------------+ |3. |Nephrology Nursing II |9×16 = 144 hours |• Case Presentation | | |(96+48 hours) = 144 hours | |• Drug Study (including Drug Interaction)| | | | |• Nursing Rounds | | | | |• Faculty Lecture | | | | |• Reflective Learning | | | | |• Narrated PPT, Video | | | | |• Directed Reading | +------+-------------------------------------------------+----------------------------+-----------------------------------------+ IInd year: Block classes - 1 week, 45 weeks - 8.5/9 hours per week Topic for every teaching method will be specified in the detailed plan by the respective teacher/institution concerned. CORE COURSES I. Theoretical Basis for Advanced Practice Nursing COMPETENCIES 1. Analyses the global healthcare trends and challenges. 2. Analyses the impact of healthcare and education policies in India on nursing consulting the documents available. 3. Develops in depth understanding of the healthcare delivery system in India, and its challenges. 4. Applies economic principles relevant to delivery of healthcare services in critical care. 5. Manages and transforms health information to effect health outcomes such as cost, quality and satisfaction. 6. Accepts the accountability and responsibility in practicing the Nurse Practitioner's roles and competencies. 7. Actively participates in collaborative practice involving all healthcare team members in critical care and performs the prescriptive roles within the authorized scope. 8. Engages in ethical practice having a sound knowledge of law, ethics and regulation of advanced nursing practice. 9. Uses the training opportunities provided through well planned preceptorship and performs safe and competent care applying nursing process/care pathways or clinical pathways. 10. Applies the knowledge of nursing theories in providing competent care to patients with kidney disorders. 11. Predicts future challenges of Nurse Practitioner's roles in variety of healthcare settings particularly in India. Hours of Instruction: Theory: 40 hours +------+-------------------------------------------------+-------+ |S.No. |Topic |Hours | +------+-------------------------------------------------+-------+ |1. |Global Health Care Challenges and Trends (Competency-1)|2 | +------+-------------------------------------------------+-------+ |2. |Health System in India |2 | | |Health Care Delivery System in India - Changing Scenario (Competency-3)| | +------+-------------------------------------------------+-------+ |3. |National Health Planning - 5-Year Plans and National Health Policy (Competency-2)|2 | +------+-------------------------------------------------+-------+ |4. |Health Economics & Health Care Financing (Competency-4)|4 | +------+-------------------------------------------------+-------+ |5. |Health Information System including Nursing Informatics (Use of Computers)|4 | | |(Competency-5) | | +------+-------------------------------------------------+-------+ |Advanced Practice Nursing (APN) | | +------+-------------------------------------------------+-------+ |6. |APN - Definition, Scope, Philosophy, Accountability, Roles & Responsibilities|3 | | |(Collaborative Practice and Nurse Prescribing Roles) (Competency-6&7)| | +------+-------------------------------------------------+-------+ |7. |Regulation (Accreditation of Training Institutions and Credentialing) &|3 | | |Ethical Dimensions of Advanced Nursing Practice Role (Competency-8)| | +------+-------------------------------------------------+-------+ |8. |Nurse Practitioner - Roles, Types, Competencies, Clinical Settings for Practice, Cultural|3 | | |Competence (Competency-6) | | +------+-------------------------------------------------+-------+ |9. |Training for NPs - Preceptorship (Competency-9) |2 | +------+-------------------------------------------------+-------+ |10. |Future Challenges of NP Practice (Competency-11) |4 | +------+-------------------------------------------------+-------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------------------------------------------------+-------+ |S.No. |Topic |Hours | +------+-------------------------------------------------+-------+ |11. |Theories of Nursing applied to APN (Competency-10)|3 | +------+-------------------------------------------------+-------+ |12. |Nursing Process/Care Pathway applied to APN (Competency-9)|2 | +------+-------------------------------------------------+-------+ |Self-Learning Assignments | | +------+-------------------------------------------------+-------+ |1. |Identify Health Care and Education Policies and analyze its impact on Nursing|6 | +------+-------------------------------------------------+-------+ |2. |Describe the legal position in India for NP practice. What is the future of nurse prescribing policies| | | |in India with relevance to these policies in other countries?| | +------+-------------------------------------------------+-------+ |3. |Examine the nursing protocols relevant to NP practice found in nephrology unit/kidney transplant| | | |unit/dialysis unit in your tertiary center | | +------+-------------------------------------------------+-------+ |Total | |40 hours| +------+-------------------------------------------------+-------+ Bibliography • AACN (2021) The essentials: Core Competencies for Professional Nursing Education Entry Level and Advanced Level Nursing Education, American Association of Colleges of Nursing • ΑΝΝΑ (2021) The Nephrology Nurses Scope and Standards of Practice: Standards of Professional Performance and Competencies, Nephrol Nurs J. 2022 Jul-Aug. • DeNisco & Barkers A.M. (2015) Advanced Practice Nursing: Essential Knowledge for the Profession (3rd ed.), Massachusetts: Jones & Bartlett Publishers Inc. • Hickey J.V., Ouimette R.M. & Venegoni S.L. (1996) Advanced Practice Nursing: Changing Roles and Clinical Applications, Philadelphia: Lippincott Williams & Wilkins • ICN (2020) Guidelines on Advanced Practice Nursing, Geneva: ICN • NONPF (2022) Nurse Practitioner Role Competencies, National Organization of Nurse Practitioner Faculties • Schober M. & Affara F.A. (2006) Advanced Nursing Practice, Oxford: Blackwell Publishing • Stewart G.J. & DeNisco S.M. (2015) Role Development for the Nurse Practitioner, USA: Springer Publishing Company II. Research Application and Evidence Based Practice in Nephrology Nursing COMPETENCIES 1. Applies sound research knowledge and skills in conducting independent research in Nephrology care setting. 2. Participates in collaborative research to improve patient care quality. 3. Interprets and uses research findings in advanced practice to produce EBP. 4. Tests/evaluates current practice to develop best practices and health outcomes and quality care in advanced practice. 5. Analyzes the evidence for nursing interventions carried out in Nephrology Nursing practice to promote safety and effectiveness of care. 6. Develops skill in writing scientific research reports. Hours of Instruction: Theory: 56 hours + Lab/Skill Lab: 24 hours = 80 hours +------+-------------------------------------------------+-------+ |S.No. |Topic |Hours | +------+-------------------------------------------------+-------+ |1 |Research and Advanced Practice Nursing |2 | | |Significance of research and inquiry related to advanced nursing role (Competency-1)| | +------+-------------------------------------------------+-------+ |2 |Research Agenda for APN Practice |5 | | |Testing current practice to develop best practice, health outcomes and indicators of quality care in| | | |advanced practice (Competency-3,4,5), promoting research culture| | +------+-------------------------------------------------+-------+ |3 |Research Knowledge and Skills |40 | | |Research competencies essential for APNs (interpretation and use of research, evaluation of| (5 days| | |practice, participation in collaborative research)|workshop)| | |Introduction to Evidence Based Practice (EBP) project - PiCOT question, steps of planning,| | | |implementation, evaluation and dissemination (project proposal and project report)| | | |Research Methodology | | | |Phases/steps (Research question, review of literature, conceptual framework, research designs,| | | |sampling, data collection, methods & tools, Analysis and Reporting)| | | |Writing research proposal and research report (Competency-1 & 2)| | +------+-------------------------------------------------+-------+ |4 |Writing for Publication |5 | | |(Writing workshop - Manuscript preparation and finding funding sources) (Competency-6)|(workshop)| +------+-------------------------------------------------+-------+ |5 |Evidence Based Practice |4 | | |Concepts, principles, importance and steps | | +------+-------------------------------------------------+-------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------------------------------------------------+-------+ |S.No. |Topic |Hours | +------+-------------------------------------------------+-------+ | |Integrating EBP to ICU environment | | | |Areas of evidence in critical care | | | |Barriers to implement EBP | | | |Strategies to promote EBP (Competency-3,4,5) | | +------+-------------------------------------------------+-------+ |Total | |56 hours| +------+-------------------------------------------------+-------+ Practical Learning & Assignments: 24 hours • Identifying research priorities • Writing exercises on research question, objectives and hypothesis • Prepare research proposal/EBP project proposal • Data Collection, analysis and interpretation • Scientific paper writing - preparation of manuscript for publication • Literature review - analyze the evidence for specific clinical practices in nephrology setting. Practicum • Dissertation (336 hours = 7 weeks)/Evidence Based Practice Project (EBP project) Bibliography • Gray J. & Grove S.K. (2020) Burns & Groves' The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence (9th ed.), St. Louis: Elsevier Saunders • Polit D.F. & Beck C.T. (2021) Nursing Research: Generating and Assessing Evidence for Nursing Practice (11th ed.), New Delhi: Wolters Kluwer • Schmidt N.A. & Brown J.M. (2021) Evidence Based Practice for Nurses' Appraisal and Application of Research, Sd: Jones & Bartlett Publishers Inc. III. Advanced Skills in Leadership, Management and Teaching COMPETENCIES 1. Applies principles of leadership and management in Nephrology unit. 2. Manages stress and conflicts effectively in any Nephrology care setting using sound knowledge of principles. 3. Applies problem solving and decision-making skills effectively. 4. Uses critical thinking and communication skills in providing leadership and managing patients care in Nephrology care settings. 5. Builds teams and motivates others in Nephrology care settings. 6. Participates appropriately in times of innovation and change. 7. Uses effective teaching methods, media and evaluation based on sound principles of teaching. 8. Develops advocacy role in patient care, maintaining quality and ethics in care delivery. 9. Provides counseling to families and patients that facilitates shared decision making on treatment plans. Hours of Instruction: Theory: 56 hours + Lab/Skill Lab: 24 hours = 80 hours +------+-------------------------------------------------+-------+ |S.No. |Topic |Hours | +------+-------------------------------------------------+-------+ |1. |Theories, styles of leadership and current trends|2 | +------+-------------------------------------------------+-------+ |2. |Theories, styles of management and current trends|2 | +------+-------------------------------------------------+-------+ |3. |Principles of leadership and management applied to Nephrology care settings|4 | +------+-------------------------------------------------+-------+ |4. |Stress management and conflict management - principles and application, effective time|4 | | |management | | +------+-------------------------------------------------+-------+ |5. |Quality improvement and audit |4 | +------+-------------------------------------------------+-------+ |6. |Problem solving, critical thinking and decision making, communication skills applied to|5 | | |Nephrology nursing practice | | +------+-------------------------------------------------+-------+ |7. |Team building, motivating and mentoring within Nephrology unit set up|2 | +------+-------------------------------------------------+-------+ |8. |Budgeting and management of resources including human resources - material, manpower, time|5 | +------+-------------------------------------------------+-------+ |9. |Change and innovation |2 | +------+-------------------------------------------------+-------+ |10. |Performance indicators for practice and performance measures|6 | +------+-------------------------------------------------+-------+ |11. |Teaching-learning theories and principles applied to Nephrology Nursing|2 | +------+-------------------------------------------------+-------+ |12. |Competency based education and outcome based education|2 | +------+-------------------------------------------------+-------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------------------------------------------------+-------+ |S.No. |Topic |Hours | +------+-------------------------------------------------+-------+ |13. |Teaching methods/strategies, media: educating patients and staff in Nephrology care settings|8 | +------+-------------------------------------------------+-------+ |14. |Staff education and use of tools in evaluation |4 | +------+-------------------------------------------------+-------+ |15. |APN - Roles as a teacher |2 | +------+-------------------------------------------------+-------+ |16. |Advocacy roles in Nephrology care environment |2 | +------+-------------------------------------------------+-------+ |Total | |56 hours| +------+-------------------------------------------------+-------+ Practice: 24 hours • Preparation of staff patient assignment • Patient care audit • Preparation of nursing care standards and protocols • Monitoring, evaluation, and writing report of infection control practices • Development of teaching plan for staff and patients using appropriate technology assisted teaching aids • Micro teaching/patient education sessions • Planning and conducting OSCE/OSPE • Quality Improvement Audit • Construction of tests • Performance indicators measurement Assignment • Prepare Nursing care standards for one of the Dialysis units Bibliography • Bastable S.B. (2019) Nurse as Educator: Principles of Teaching and Learning for Nursing Practice (5th ed.), New Delhi: Jones & Bartlett Publishers Inc. • Billings D.M. & Halstead J.A. (2019) Teaching in Nursing: A Guide for Faculty (6th ed.), St. Louis, Missouri: Saunders Elsevier • Clark C.C. (2010) Creative Nursing Leadership and Management, New Delhi: Jones & Bartlett Publishers Inc. • Liebler J.G. & McConnel C.R. (2008) Management Principles for Health Professionals, Sudbury, M.A: Jones & Bartlett Publishers Inc. • Roussel L. & Swansburg R.C. (2010) Management and Leadership for Nurse Administrators (5th ed.), New Delhi: Jones & Bartlett Publishers Inc. ADVANCED PRACTICE COURSES IV. Advanced Pathophysiology applied to Nephrology Nursing COMPETENCIES 1. Integrates the knowledge of pathophysiological process in kidney care in developing diagnosis and plan of care. 2. Applies the pathophysiological principles in symptom management and secondary prevention of complications related to kidney disease. 3. Analyzes the pathophysiological changes relevant to each condition requiring kidney transplant recognizing the value of diagnosis, treatment, care and prognosis. IV. A. Advanced Pathophysiology applied to Nephrology Nursing Hours of Instruction: Theory: 30 hours +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ |I |10 |Review of Anatomy and Physiology of Kidneys and Urinary system | | | |• Macroscopic structure of Kidney, Ureter, Bladder | | | |• Microscopic structure of Kidney | | | |• Physiology of Urine Formation | | | | Ο Glomerular filtration | | | | Ο Tubular Reabsorption | | | | Ο Tubular secretion | | | |• Renin Angiotensin Mechanism | | | |• Functions of Kidney, Ureter, Bladder | +------+-------+----------------------------------------------------------------------------------------------------------------+ |II |7 |Fluid and Electrolyte Regulation and Imbalances | | | |• Fluid Distribution in the body | +------+-------+----------------------------------------------------------------------------------------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ | | |• Fluid regulation mechanisms in the body | | | |• Electrolyte distribution, Role of Electrolytes (Sodium, potassium, calcium, phosphorus, | | | | magnesium) | | | |• Identifying and Managing Fluid and Electrolyte imbalances | | | | Ο Water | | | | Ο Sodium | | | | Ο Potassium | | | | Ο Phosphorous | | | | Ο Calcium | | | | Ο Magnesium | +------+-------+----------------------------------------------------------------------------------------------------------------+ |III |5 |Acid Base Regulation and Imbalances | | | |• Acid Base regulatory mechanisms in the body | | | |• Compensatory mechanism | | | |• Effect of Acid Base balance in the body | | | |• Normal Values | | | |• Identifying Acid base imbalances | | | |• Interpretation of ABG analysis results | +------+-------+----------------------------------------------------------------------------------------------------------------+ |IV |8 |Anatomy and Physiology of related systems | | | |• Cardiac physiology | | | |• Interpretation of ECG | | | |• Respiratory system | | | |• Endocrine system | | | |• Nervous system | +------+-------+----------------------------------------------------------------------------------------------------------------+ |Total |30 hours| | +------+-------+----------------------------------------------------------------------------------------------------------------+ IV.B. Advanced Pathophysiology applied to Nephrology Nursing Hours of Instruction: Theory: 30 hours +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ |I |5 |Hematological function | | | |• Composition of Blood | | | |• Types of blood cells | | | |• Formation of Blood cells | | | |• Blood Groups | | | |• Hematocrit | | | |• Clotting Mechanism | | | |• Common hematological problems in kidney disease | +------+-------+----------------------------------------------------------------------------------------------------------------+ |II |3 |Integumentary function | | | |• Advanced pathophysiological process of integumentary conditions | | | |• Wound healing | | | |• Burns | | | |• Steven Johnson Syndrome | | | |• Skin changes in Kidney Disorders | +------+-------+----------------------------------------------------------------------------------------------------------------+ |III |5 |Multisystem dysfunction | | | |• Shock | | | | Ο Hypovolemic | | | | Ο Cardiogenic | | | | Ο Distributive | | | |• Systemic inflammatory syndrome | | | |• Multiple organ dysfunction syndrome | | | |• Sepsis | | | |• Drug overdose and poisoning | | | |• Envenomation | +------+-------+----------------------------------------------------------------------------------------------------------------+ |IV |5 |Specific infections | | | |• Advanced pathophysiological process of specific infections | | | |• HIV | +------+-------+----------------------------------------------------------------------------------------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ | | |• Tetanus | | | |• SARS, COVID | | | |• Hepatitis A | | | |• Hepatitis B | | | |• Leptospirosis | | | |• Dengue | | | |• Malaria | | | |• Tuberculosis | +------+-------+----------------------------------------------------------------------------------------------------------------+ |V |4 |Reproductive functions | | | |• Kidney Injury from: | | | | Ο Antepartum hemorrhage | | | | Ο Pregnancy induced hypertension, Pre-eclampsia | | | | Ο HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet Count) | | | | Ο Postpartum hemorrhage | | | | Ο Puerperal sepsis | +------+-------+----------------------------------------------------------------------------------------------------------------+ |VI |8 |Basic Immunology | | | |• Immunoglobulins | | | |• Antigen Antibody reactions | | | |• Cross matching | | | |• Cell mediated Immunity | | | |• Immediate and Delayed hypersensitivity | | | |• Autoimmunity | | | |• Transplant immunology | | | |• HLA Typing | +------+-------+----------------------------------------------------------------------------------------------------------------+ |Total |30 hours| | +------+-------+----------------------------------------------------------------------------------------------------------------+ Bibliography • Berkowitz A. (2021) Clinical Pathophysiology (2nd ed.), MedMaster Inc. • Huether S.E., McCance K.L. & Brashers V.L. (2019) Understanding Pathophysiology (7th ed.), St. Louis, Missouri: Elsevier • Norris T.L. (2020) Porth's Essentials of Pathophysiology (5th ed.), Wolters Kluwer • Porth C.M. (2007) Essentials of Pathophysiology: Concepts of Altered Health States (4th ed.), Philadelphia: Lippincott Williams & Wilkins • Story L. & Dlugasch L. (2019) Advanced Pathophysiology for the Advanced Practice Nurse (1st ed.), Jones & Bartlett Publishers Inc. • Willis L.M. (2019) Professional Guide to Pathophysiology (4th ed.), LWW V. Advanced Pharmacology applied to Nephrology Nursing COMPETENCIES 1. Applies the pharmacological principles in providing care to patients with kidney disorders. 2. Analyzes pharmaco-therapeutics and pharmacodynamics relevant to drugs used in the treatment of nephrology conditions. 3. Performs safe drug administration based on principles and institutional protocols. 4. Documents accurately and provides follow up care. 5. Applies sound knowledge of drug interactions in administration of drugs to patients in the nephrology care settings and guiding their families in self-care management. THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Hours of Instruction: Theory: 54 hours +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ |I |2 |Introduction to Pharmacology | | | |• History | | | |• Classification of drugs and schedules | +------+-------+----------------------------------------------------------------------------------------------------------------+ |II |3 |Pharmacokinetics and Pharmaco-dynamics | | | |• Introduction | | | |• Absorption, distribution, metabolism and excretion in critical care | | | |• Plasma concentration, half life | | | |• Loading and maintenance dose | | | |• Therapeutic index and drug safety | | | |• Potency and efficacy | | | |• Principles of drug administration | | | | Ο The rights of drug administration | | | | Ο Systems of measurement | | | | Ο Enteral drug administration | | | | Ο Topical drug administration | | | | Ο Parenteral drug administration | +------+-------+----------------------------------------------------------------------------------------------------------------+ |III |5 |Pharmacology and Cardiovascular alterations | | | |• Vasoactive Medications | | | |• Vasodilator, Vasopressors, Inotropes | | | |• Cardiac glycosides - Digoxin | | | |• Sympathomimetics - Dopamine, dobutamine, epinephrine, isoproterenol, norepinephrine, | | | | phenylephrine | | | |• Phosphodiesterase inhibitors - amrinone, milrinone | | | |• Antiarrhythmic Medications | | | |• Cardiac conditions | | | |• Medications to improve cardiac contractility | | | |• Medications in the management of heart failure | | | |• Medications in the management of angina pectoris and myocardial infarction | | | |• Medications in the management of dysrhythmias, Heart block and conduction disturbances | | | |• Medications in the management of Pulmonary hypertension, | | | |• Medications in the management of Atherosclerotic disease of aorta and Peripheral artery | | | | disease | | | |• Medications in the management of Deep vein thrombosis | +------+-------+----------------------------------------------------------------------------------------------------------------+ |IV |4 |Medications in management of infection | | | |Indications, Mechanism of action, Dose, route, Administration guidelines, Adverse effects of drugs | | | |under: | | | |• Antibacterial drugs | | | |• Antibiotics against | | | | Ο Gram positive bacteria | | | | Ο Gram negative bacteria | | | |• First, Second, Third and Fourth generation antibiotics | | | |• Antibiotic resistance | | | |• Antifungal agents | | | |• Antiviral agents | | | |• Antiprotozoal drugs | +------+-------+----------------------------------------------------------------------------------------------------------------+ |V |4 |Medications in Management of Hypertension | | | |• Diuretics | | | |• Calcium channel blockers | | | |• Beta adrenergic blockers | | | |• Alpha Adrenergic blockers | | | |• Angiotensin Converting Enzyme inhibitors | | | |• Angiotensin Receptor Blockers | +------+-------+----------------------------------------------------------------------------------------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ |VI |5 |Medications in Management of Hyperglycemia (Glucose Lowering Agents) | | | |• Sulfonylureas (glipizide, glyburide, gliclazide, glimepiride) | | | |• Meglitinides (repaglinide and nateglinide) | | | |• Biguanides (metformin) | | | |• Thiazolidinediones (rosiglitazone, pioglitazone) | | | |• a-Glucosidase inhibitors (acarbose, miglitol, voglibose) | | | |• DPP-4 inhibitors (Sitagliptin, Saxagliptin, Vildagliptin, Linagliptin, Alogliptin) | | | |• SGLT2 inhibitors (Dapagliflozin and Canagliflozin) | | | |• Cycloset (Bromocriptine) | | | |Insulin | | | |• Rapid-acting insulin | | | |• Short-acting insulin | | | |• Intermediate-acting insulin | | | |• Mixed insulin | | | |• Long-acting insulin | +------+-------+----------------------------------------------------------------------------------------------------------------+ |VII |4 |Pharmacology and Pulmonary alterations | | | |• Medications used on patients on mechanical ventilation | | | |• Medications in the management of Pulmonary edema | | | |• Medications in the management of Pulmonary embolism | | | |• Medications in the management of Acute respiratory failure and acute respiratory distress | | | | syndrome | | | |• Medications in the management of Chronic obstructive pulmonary disease | | | |• Medications in the management of Pneumonia | | | |• Medications in the management of Pleural effusion | +------+-------+----------------------------------------------------------------------------------------------------------------+ |VIII |6 |Pharmacology in management of Pain and anxiety | | | |• Pain | | | | Ο NSAID | | | | Ο Opioid analgesia | | | |• Sedation | | | | Ο Gamma amino butyric acid stimulants | | | | Ο Dexmedetomidine | | | | Ο Analgosedation | | | |• Delirium | | | | Ο Haloperidol | | | | Ο Atypical anti-psychotics | | | |• Medications used for local and general anesthesia | | | | Ο Local - Amides, esters, and miscellaneous agents | | | | Ο General - Gases, Volatile liquids, IV anesthetics | | | | Ο Non anesthetic drugs adjuncts to surgery | | | |• Paralytic Medications | | | | ○ Non-depolarizing and depolarizing agents | | | | ○ Anxiolytics | | | |• Autonomic drugs | | | | Ο Adrenergic agents/Sympathomimetics | | | | Ο Adrenergic blocking agents | | | | Ο Cholinergic agents | | | | Ο Anti-cholinergic agents | | | |• Medications in the management of anxiety and insomnia | | | | Ο Antidepressants | | | | Ο Benzodiazepines | | | | Ο Barbiturates | +------+-------+----------------------------------------------------------------------------------------------------------------+ |IX |7 |Pharmacology and Nephrology alterations | | | |• Diuretics | | | |• Fluid replacement | | | | Ο Crystalloids | | | | Ο Colloids | | | |• Electrolytes | +------+-------+----------------------------------------------------------------------------------------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ | | | Ο Sodium | | | | Ο Potassium | | | | Ο Calcium | | | | Ο Magnesium | | | | Ο Phosphorus | | | |• Nephrology conditions | | | | Ο Medications in the management of Acute/Chronic Kidney Disease | | | | Ο Medications in the management of Acute tubular necrosis | | | |• Medications in the management of Bladder Outlet Obstructions | | | | Ο Medications in the management of Electrolyte imbalances | | | | Ο Medications in the management of Acid base imbalances | | | | Ο Medications used during dialysis | | | | Ο Nephrotoxic drugs | | | |• Standing orders for nephrology critical care emergencies | +------+-------+----------------------------------------------------------------------------------------------------------------+ |X |4 |Pharmacology and Gastrointestinal alterations | | | |• Anti-ulcer drugs | | | |• Laxatives | | | |• Anti diarrheal | | | |• Anti emetics | | | |• Pancreatic enzymes | | | |• Nutritional supplements, Vitamins and minerals | +------+-------+----------------------------------------------------------------------------------------------------------------+ |XI |4 |Pharmacology and Hematology alterations in Nephrology | | | |• Anticoagulants | | | |• Antiplatelet drugs | | | |• Thrombolytics | | | |• Hemostatic/antifibrinolytics | | | |• Hematopoietic growth factors | | | | ○ Erythropoietin | | | | O Colony stimulating factors | | | | Ο Platelet enhancers | | | |• Blood & Blood Components | | | |• Vaccines | +------+-------+----------------------------------------------------------------------------------------------------------------+ |XII |6 |Immunosuppressant Drugs in Nephrology | | | |• Induction agents | | | | Polyclonal antibodies (ATG) | | | | Ο Interleukin 2 receptor antagonists (Basiliximab) | | | |• Maintenance Therapy | | | | Ο Calcineurin inhibitors (Cyclosporin, Tacrolimus) | | | | Ο mTOR inhibitors (Sirolimus, Everolimus) | | | | Ο Antiproliferative agents (Azathioprine, Mycophenolic acid) | | | | Ο Corticosteroids (Prednisolone) | | | |• Treatment for rejection | | | |• Corticosteroids, ATG, IVIG | +------+-------+----------------------------------------------------------------------------------------------------------------+ |Total |54 hours| | +------+-------+----------------------------------------------------------------------------------------------------------------+ Bibliography • Hari Varun Kalluri, Karen L. Hardinger, Current State of Renal Transplant Immunosuppression: Present and Future, World J Transplant 2012 Aug (24), 2(4): 51-68 • Eisen H.J. (2020) Pharmacology of Immunosuppression (1st ed.), Springer • McKay G.A. & Walters M.R. (2021) Clinical Pharmacology and Therapeutics (10th ed.), Wiley-Blackwell • SHERYL F. VONDRACEK & ISAAC TEITEBAUM, PRINCIPLES OF KIDNEY PHARMACOTHERAPY FOR THE NEPHROLOGIST: CORE CURRICULUM 2021, NATIONAL KIDNEY FOUNDATION, AMERICAN JOURNAL OF KIDNEY DISEASES, JULY 16 2021 • Wynne A.L., Woo T.M., Sheryl & Olyaei A.J. (2007) Pharmacotherapeutics for Nurse Practitioner Prescribers (2nd ed.), Philadelphia: Davis IX. Nephrology Nursing II Hours of Instruction: Theory: 96 hours + Lab/Skill Lab: 48 hours = 144 hours +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ |I |25 |Hemodialysis (HD) | | | |• History and Overview | | | |• Principles and Concepts | | | |• Procedure of hemodialysis | | | |• Initiating patients on HD: Guidelines | | | |• Dialysis machine - Parts, functioning | | | |• Dialysis efficiency | | | |• Dry weight assessment | | | |• Dialysis Adequacy | | | |• Assessment of patients before, during and after HD | +------+-------+----------------------------------------------------------------------------------------------------------------+ THE GAZTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ | | |• Complications in HD: Prevention, Identification, Management | | | |• Dialysis Modalities including CRRT | | | |• CVC as Vascular access and Guidelines in CVC care | | | |• Arterio-Venous Fistula and AV graft as Vascular access and evidence based guidelines in | | | | management of AVF and AVG | | | |• Assessment of Vascular access | | | |• Vascular access related complications - Identification and management | | | |• UF and Sodium Profiling | | | |• Bicarbonate preparation | | | |• Disinfection protocols - Machine, RO tank, pipelines | | | |• Assurance of water quality (Purification process, Surveillance) | | | |• Nutritional considerations in HD | | | |• Comprehensive, holistic care of patients on HD | | | |• Insertion of CVC - temporary, permanent | | | |• Plasmapheresis | | | |• Infection Control Practices | | | |• Quality Assurance in HD | | | |• Recent trends and developments in HD | +------+-------+----------------------------------------------------------------------------------------------------------------+ |II |20 |Peritoneal Dialysis (PD) | | | |• History and overview | | | |• Principles and Concepts in PD | | | |• Types of PD modalities including Automated PD | | | |• PD Exchange procedure | | | |• Selection of patients for PD based on assessment | | | |• PD prescription, PET, PD fluids | | | |• PD Adequacy | | | |• Infectious and non-infectious complications of PD: Identification and management | | | |• PD catheter insertion - percutaneous and Open | | | |• Care of patients before, during and following PD catheter insertion | | | |• Identification and management of peritonitis | | | |• Advantages and Disadvantages of PD | | | |• Nutritional Considerations in PD | | | |• Education and Counseling of patients and families | | | |• Evidence based practices in PD | | | |• Comprehensive and Holistic care of patients on PD and their families | | | |• Recent trends in PD | +------+-------+----------------------------------------------------------------------------------------------------------------+ |III |25 |Kidney Transplant | | | |• History and Overview | | | |• Surgical Procedure | | | |• Types of Transplants | | | |• Preparation of Donor and recipients for Transplant | | | |• Transplant Immunology | | | |• Early and late complications of Kidney Transplant - Identification and management | | | |• Graft rejection: prevention, identification, management | | | |• Drug assays, Immuno-suppressant therapy | | | |• Care of patients following kidney transplant | | | |• Fluid management protocol in RTU | | | |• Infection Control practices in RTU | | | |• Donor and recipient follow-up | | | |• Standing orders in RTU | | | |• Drug protocols | | | |• Microbiology Surveillance, Quality Assurance in PD | | | |• Recent trends and developments in kidney transplant therapy | | | |• NOTTO | +------+-------+----------------------------------------------------------------------------------------------------------------+ |IV |4 |Healthy Living Post-transplant | +------+-------+----------------------------------------------------------------------------------------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +------+-------+----------------------------------------------------------------------------------------------------------------+ |Unit |Hours |Content | +------+-------+----------------------------------------------------------------------------------------------------------------+ | | |• Discharge preparation of donor and recipient | | | |• Rehabilitation & follow up | | | |• Healthy lifestyle including nutrition, rest, exercise | | | |• Health risks and surveillance post-transplant | | | |• Sexuality | | | |• Safe living after transplantation | | | |• QOL issues - post transplant | +------+-------+----------------------------------------------------------------------------------------------------------------+ |V |4 |Psycho-social issues in Transplantation | | | |• Psychological impact of transplant in donor and recipient | | | |• Psychosocial assessment of donor and recipient | | | |• Prevention: multidisciplinary care | | | |• Role of nurse | | | |• Role of support groups | +------+-------+----------------------------------------------------------------------------------------------------------------+ |VI |4 |Transplant in Children | | | |• Donor | | | |• Receipt clinical concerns following organ transplantation in children | +------+-------+----------------------------------------------------------------------------------------------------------------+ |VII |4 |Education and Counselling | | | |• Right to the correct information | | | |• Principles of adult learning | | | |• Effective communication skills | | | |• Preparation of information sharing tools | | | |• Shared decision-making process | | | |• Education methods and strategies | +------+-------+----------------------------------------------------------------------------------------------------------------+ |VIII |4 |Special Considerations | | | |• HD in Acutely ill patients | | | |• Acute PD | | | |• PD in pregnancy | | | |• Management of Anemia | | | |• Dialysis and Transplant in children and elderly | +------+-------+----------------------------------------------------------------------------------------------------------------+ | |6 |Class tests | +------+-------+----------------------------------------------------------------------------------------------------------------+ |Total |96 hours| | +------+-------+----------------------------------------------------------------------------------------------------------------+ List of skills to be practiced (48 hours include demonstration by the faculty and practice by the students). Hemodialysis • Pre, Intra, Post dialysis assessment • Assessment of Vascular Access - CVC, AVF, AVG • CVC site care • Dry Weight assessment - clinical and bio-impedance method • UF calculation, programming machine, starting HD • Closing HD • Bicarb preparation • Heparin preparation • Drug reciliation • Estimating URR, Kt/V, Assess dialysis adequacy • Prescribe routine investigations and follow up results • HD prescription • Prescription of common drugs based on lab reports: Erythropoietin, Phosphorous binders, Calcium and Vitamin D supplements, Antihypertensives, OGLA • Insulin dose adjustment • Perform varied dialysis modalities - SCUF, Isolated UF, SLED, CRRT • Perform Plasmapheresis • Calculate plasma volume for removal • Insertion of CVC into femoral and jugular vein THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • Urine culture - SPC • CVC removal • Blood culture • Ascitic tap Peritoneal Dialysis • Assess and Select patients for PD • Perform PET, Determine PD prescription • Perform PD exchanges • Collect PD Fluid for culture • Identify and manage Exit site infection, Tunnel infection and peritonitis • Administer intraperitoneal antibiotics • Alter PD prescription based on clinical assessment and PET • Assess Dialysis adequacy including Kt/V • Identify and manage noninfectious complications of PD The skills listed under the Specialty courses such as Foundations of Nephrology Nursing Practice, Nephrology Nursing I and Nephrology Nursing II are taught by the faculty in skill lab. The students after practicing them in the lab, will continue to practice in the respective clinical areas. 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. Bibliography • Dakshinamurty K.V., Sivakumar V. & Sangeetha Lakshmi (2017) Peritoneal Dialysis Primer (1st ed.), Biocon India Limited • Danowich (2018) Handbook of Kidney Transplantation (6th ed.), Wolters Kluwer • John T. Daugridas & Peter G. Blake (2015) Handbook of Dialysis (South Asian 5th ed.), Wolters Kluwer • Joyce M. Black (2009) Medical-Surgical Nursing: Clinical Management for Positive Outcomes (8th ed.), USA: W.B. Saunders Company • Richard J. Johnson, Jurgen Floege & Marcello Tonelli (2023) Comprehensive Clinical Nephrology (7th ed.), Elsevier's Company Appendix-1 EQUIPMENT LIST FOR A NEPHROLOGY UNIT (20 beds) +-----+------------------------------------------------+----------+ |No. |Description |Quantity | +-----+------------------------------------------------+----------+ |1. |Adjustable electronic cot with mattress |20 | +-----+------------------------------------------------+----------+ |2. |IV stand |10 | +-----+------------------------------------------------+----------+ |3. |Bed side locker |20 | +-----+------------------------------------------------+----------+ |4. |Over bed trolley |10 | +-----+------------------------------------------------+----------+ |5. |Dressing trolley (small) |5 | +-----+------------------------------------------------+----------+ |6. |Dressing trolley (medium) |2 | +-----+------------------------------------------------+----------+ |7. |Syringe pump |4 | +-----+------------------------------------------------+----------+ |8. |Infusion pump |5 | +-----+------------------------------------------------+----------+ |9. |Monitors |5 | +-----+------------------------------------------------+----------+ |10. |Transport monitor/pulse oximeter |5 | +-----+------------------------------------------------+----------+ |11. |ECG machine |1 | +-----+------------------------------------------------+----------+ |12. |Ultrasound machine |1 | +-----+------------------------------------------------+----------+ |13. |CART trolley |1 | +-----+------------------------------------------------+----------+ |14. |Defibrillator |1 | +-----+------------------------------------------------+----------+ |15. |Alpha mattress with motor |3 | +-----+------------------------------------------------+----------+ |16. |Transfer trolley |4 | +-----+------------------------------------------------+----------+ |17. |OR trolley |2 | +-----+------------------------------------------------+----------+ |18. |Safe slider |2 | +-----+------------------------------------------------+----------+ |19. |Computer |2 | +-----+------------------------------------------------+----------+ |20. |Printer |1 | +-----+------------------------------------------------+----------+ |21. |Bain circuit |12 | +-----+------------------------------------------------+----------+ |22. |Oxygen flow meter |20 | +-----+------------------------------------------------+----------+ |23. |Suction port with jar |20 | +-----+------------------------------------------------+----------+ |24. |Air flow meter/pulmoaid |5 | +-----+------------------------------------------------+----------+ |25. |Refrigerator (feeds - 1, drugs - 1) |2 | +-----+------------------------------------------------+----------+ |26. |Metal foot step/foot stool |5 | +-----+------------------------------------------------+----------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] |No. |Description |Quantity | +-----+---------------------------------|----------| |27. |Ambulation chair |5 | +-----+---------------------------------+----------+ |28. |UPS |1 | +-----+---------------------------------+----------+ |29. |Flat trolley |1 | +-----+---------------------------------+----------+ |30. |Labelling machine |1 | +-----+---------------------------------+----------+ |31. |Glucometer |2 | +-----+---------------------------------+----------+ |32. |Ambu bag with different sizes |2 sets | +-----+---------------------------------+----------+ Hemodialysis Unit (10 beds) - some of the listed requirement may vary based on the number of dialysis shifts |No. |Description |Quantity | +-----+------------------------------------------------+----------+ |1. |Dialysis machines |10 | +-----+------------------------------------------------+----------+ |2. |Bicarbonate preparation tank |1 | +-----+------------------------------------------------+----------+ |3. |Water treatment plant with RO, Endotoxin filter |1 | +-----+------------------------------------------------+----------+ |4. |Dialysis pipelines that are compatible to chemical/heat disinfection| | +-----+------------------------------------------------+----------+ |5. |Dialyzers and tubings | | +-----+------------------------------------------------+----------+ |6. |Infusion pump |1 | +-----+------------------------------------------------+----------+ |7. |Syringe pump |1 | +-----+------------------------------------------------+----------+ |8. |Patient monitors |5 | +-----+------------------------------------------------+----------+ |9. |CART trolley |1 | +-----+------------------------------------------------+----------+ |10. |Defibrillator |1 | +-----+------------------------------------------------+----------+ |11. |Vacuum and oxygen lines for all the beds | | +-----+------------------------------------------------+----------+ |12. |Oxygen flow meters |10 | +-----+------------------------------------------------+----------+ |13. |Ventilator |1 | +-----+------------------------------------------------+----------+ |14. |Cannulation sets |20 | +-----+------------------------------------------------+----------+ |15. |CVC sets |20 | +-----+------------------------------------------------+----------+ |16. |Machine reprocessing unit (if dialyzers are reused)| | +-----+------------------------------------------------+----------+ |17. |Computers |2 | +-----+------------------------------------------------+----------+ |18. |Printer |1 | +-----+------------------------------------------------+----------+ |19. |Small dressing trolleys |10 | +-----+------------------------------------------------+----------+ |20. |Large dressing trolley |1 | +-----+------------------------------------------------+----------+ |21. |Over bed tables |10 | +-----+------------------------------------------------+----------+ |22. |Cots/Dialysis chairs |10 | +-----+------------------------------------------------+----------+ |23. |Minor OR with OR table, Lights |1 (for procedures as CVC and PD catheter insertions)| +-----+------------------------------------------------+----------+ |24. |Electronic platform weighing scale |1 | +-----+------------------------------------------------+----------+ |25. |Electronic BP monitor |1 | +-----+------------------------------------------------+----------+ |26. |Pulse oximeter |2 | +-----+------------------------------------------------+----------+ |27. |Glucometer |2 | +-----+------------------------------------------------+----------+ |28. |Wheel chairs |5 | +-----+------------------------------------------------+----------+ |29. |Stretcher |2 | +-----+------------------------------------------------+----------+ |30. |Storage racks | | +-----+------------------------------------------------+----------+ |31. |Filing cabinets | | +-----+------------------------------------------------+----------+ |32. |Refrigerators |2 | +-----+------------------------------------------------+----------+ Renal Transplant Unit - 5 beds |No. |Description |Quantity | +-----+---------------------------------+----------+ |1. |Infusion pumps |4 | +-----+---------------------------------+----------+ |2. |Syringe pump |2 | +-----+---------------------------------+----------+ |3. |Patient Monitors |5 | +-----+---------------------------------+----------+ |4. |CART trolley |1 | +-----+---------------------------------+----------+ |5. |Defibrillator |1 | +-----+---------------------------------+----------+ |6. |vacuum and oxygen lines for all the beds| | +-----+---------------------------------+----------+ |7. |Oxygen flow meters |5 | +-----+---------------------------------+----------+ |8. |Ventilator |1 | +-----+---------------------------------+----------+ |9. |Freezer |1 | +-----+---------------------------------+----------+ |10. |Refrigerator |2 | +-----+---------------------------------+----------+ |11. |Microwave oven |1 | +-----+---------------------------------+----------+ |12. |Computers |2 | +-----+---------------------------------+----------+ |13. |Printer |1 | +-----+---------------------------------+----------+ |14. |Small dressing trolleys |5 | +-----+---------------------------------+----------+ |15. |Large dressing trolley |1 | +-----+---------------------------------+----------+ |16. |Over bed tables |5 | +-----+---------------------------------+----------+ |17. |Adjustable cots |5 | +-----+---------------------------------+----------+ |18. |AC with HEPA filter |1 | +-----+---------------------------------+----------+ |19. |Electronic weighing scale |1 | +-----+---------------------------------+----------+ |20. |Electronic BP monitor |1 | +-----+---------------------------------+----------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] |No. |Description |Quantity | +-----+--------------------+----------+ |21. |Pulse oximeter |2 | +-----+--------------------+----------+ |22. |Glucometer |2 | +-----+--------------------+----------+ |23. |Wheel chairs |3 | +-----+--------------------+----------+ |24. |Stretcher |2 | +-----+--------------------+----------+ |25. |Ambulation chairs |5 | +-----+--------------------+----------+ Appendix-2 ASSESSMENT GUIDELINES (including OSCE guidelines) INTERNAL ASSESSMENT (Theory and Practical) Ist year 1. Theoretical Basis for Advanced Practice Nursing College examination of theory only: 50 marks Internal assessment: Test paper/Quiz: 10 marks Written assignment/term paper: 10 marks (Global and national healthcare trends & policies) Clinical seminar: 5 marks (Clinical/Care pathway in specific clinical condition/Application of specific nursing theory) Final theory college exam: 25 marks Total marks: 50 marks 2. Research Application and Evidence Based Practice in Nephrology Nursing Theory: Test papers: 20 marks Written assignment: 5 marks (Literature review/Preparation of research instrument) Journal club : 5 marks (Analysis of research evidence for competencies in Nephrology Nursing) Total: 30 marks 3. Advanced Skills in Leadership, Management and Teaching Theory: Test papers: 15 marks Journal club: 5 marks (Trends in Leadership/Management/Teaching) Written assignment: 5 marks (Designing an ideal Dialysis Unit and Renal Transplant Unit) Microteaching: 5 marks Total: 30 marks 4. Advanced Pathophysiology & Advanced Pharmacology applied to Nephrology Nursing Theory: Test papers and Quiz: 20 marks (Pathophysiology - 10, Pharmacology - 10) Drug studies:5 marks (Drug study and presentation) Case presentation and case study report (Pathophysiology): 5 marks Total: 30 Marks 5. Advanced Health/Physical Assessment Theory: Test papers: 20 marks Written assignment: 10 marks (Diagnostic/investigatory reports - interpretation and analysis of findings) Total: 30 marks Practicum: Clinical performance evaluation: 10 marks End of posting exam (OSCE): 10 marks Case presentation and case study report: 5 marks Internal OSCE: 25 marks Total Internal practical: 50 marks (End of posting exam may be conducted in nephrology ward, Hemodialysis unit, Peritoneal dialysis unit or transplant unit) THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] IInd year 1. Foundations of Nephrology Nursing Practice Theory: Test papers and Quiz: 20 marks Written assignment: 10 marks Total: 30 marks Practicum: Clinical Performance evaluation: 20 marks End of posting exam (OSCE): 10 marks Drug studies (Drug study and presentation): 10 marks Case presentation and case study report (Family education/counseling): 5 marks Case presentation (Application of Clinical/Care Pathway): 5 marks Internal OSCE: 50 marks Total Internal practical: 100 marks 2. Nephrology Nursing I Theory: Test papers and Quiz: 20 marks Clinical seminar and Journal club: 10 marks Total: 30 marks Practicum: Clinical performance evaluation: 20 marks End of posting exam (OSCE): 10 marks Clinical presentation: 10 marks Case study report: 10 marks Internal OSCE: 50 marks Total Internal practical: 100 marks 3. Nephrology Nursing II Theory: Test papers: 20 marks Clinical Seminar: 10 marks Total: 30 marks Practicum: Clinical performance evaluation: 20 marks End of posting exam (OSCE): 10 marks Clinical presentation: 10 marks Case study report (developed clinical/care pathway): 10 marks Internal OSCE:50 marks Total Internal practical: 100 marks (End of posting exam may be conducted in nephrology ward, dialysis unit or transplant unit) 4. Dissertation/EBP Project Practicum: 50 marks EXTERNAL (FINAL) EXAMINATION (As per schedule in syllabus) Theory: Short answer and essay type questions (Weightage can be decided by the University) {Essay 2×15 marks = 30, Short answers 5×6 marks = 30, Very short 5×2 marks = 10} OSCE GUIDELINES FOR INTERNAL AND EXTERNAL PRACTICAL EXAMINATION Ist year 1. ADVANCED HEALTH/PHYSICAL ASSESSMENT INTERNAL OSCE: 25 marks CORE COMPETENCY DOMAINS TO BE EXAMINED 1. Focused history taking and physical examination of adult patient THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 2. Focused history taking and physical examination of pediatric patient 3. Interpretation of findings and results 4. Monitoring of clinical parameters Number of stations: 5 (4+1 Rest station) Time for each station: 10 minutes Marks for each station: 5 marks (as per competency check list and allotted marks) Total: 4×5 = 20 marks Oral exam = 5 marks Total = 25 marks EXTERNAL OSCE:50 marks CORE COMPETENCY DOMAINS 1. Focused history taking of adult patient 2. Focused physical examination of adult patient 3. Focused history taking of pediatric patient 4. Focused physical examination of pediatric patient 5. Interpretation of history and physical exam findings 6. Interpretation of results of lab and diagnostic tests 7. Monitoring clinical parameters Number of stations: 10 (8+2 Rest stations) Time for each station: 10 minutes Marks for each station: 5 marks (as per competency check list and allotted marks) Total: 8×5 = 40 marks Oral exam = 10 marks Total = 50 marks On completion of procedural competencies in log book and clinical requirements, the NP student is qualified to appear for final practical examination IInd year 1. FOUNDATIONS OF NEPHROLOGY NURSING PRACTICE INTERNAL OSCE: 50 Marks CORE COMPETENCY DOMAINS TO BE EXAMINED 1. Focused history and physical examination and interpretation of findings and results 2. Monitoring competencies (invasive and noninvasive) 3. Therapeutic interventions - (emergency procedural competencies) including drug administration 4. Family education and counseling Number of stations: 5 (4+1 Rest station) Time for each station: 10 minutes Marks for each station: 10 marks (as per competency check list and allotted marks) Total: 10×4 = 40 marks Oral exam = 10 marks Total = 50 marks EXTERNAL OSCE:100 marks CORE COMPETENCY DOMAINS 1. Focused history taking, physical examination and interpretation of results of adult patient 2. Focused history taking, physical examination and interpretation of results of pediatric patient 3. Monitoring competencies (invasive and noninvasive) 4. Development of care plan 5. Family education and counseling 6. Therapeutic interventions (emergency procedural competencies) including drug administration Number of stations: 10 (8+2 Rest stations) THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Time for each station: 10 minutes Marks for each station: 10 marks (as per competency check list and allotted marks) Total: 8×10 = 80 marks Oral exam = 20 marks Total = 100 marks 2. NEPHROLOGY NURSING I & II INTERNAL OSCE-50 marks CORE COMPETENCY DOMAINS 1. Focused history and physical examination and interpretation of findings and results 2. Monitoring competencies (invasive and noninvasive) 3. Therapeutic procedures (CVC insertion, PD catheter insertion, hemodialysis, peritoneal dialysis, plasmapheresis, CRRT, SLED) 4. Development of plan of care/care pathway 5. Diagnostic interventions (Renal biopsy, Ascitic tap, Blood culture, CVC and PD catheter site culture, PD Fluid culture, PET Test, Suprapubic urine aspirate for culture, Ultrasound kidneys, Ultrasonography - AV access flow) 6. Drug prescription and administration 7. Hemodialysis 8. Peritoneal Dialysis 9. Kidney Transplantation – pre- and post-transplant care Number of stations: 5 (4+1 Rest station) Time for each station: 10 minutes Marks for each station: 10 marks (as per competency check list and allotted marks) Total: 10×4 = 40 marks Oral exam = 10 marks Total = 50 marks EXTERNAL OSCE:100 marks CORE COMPETENCY DOMAINS 1. Focused history taking, physical examination and interpretation of results of adult patient 2. Focused history taking, physical examination and interpretation of results of pediatric patient 3. Monitoring competencies (invasive and noninvasive) 4. Development of plan of care/care pathway 5. Family education and counseling 6. Drug administration 7. Diagnostic interventions (Renal biopsy, Ascitic tap, Blood culture, CVC and PD catheter site culture, PD Fluid culture, PET Test, Suprapubic urine aspirate for culture, Ultrasound kidneys, Ultrasonography - AV access flow) 8. Therapeutic interventions (hemodialysis, peritoneal dialysis, CVC insertion, PD catheter insertions, plasmapheresis, CRRT, SLED) Number of stations: 10 (8+2 Rest stations) Time for each station: 10 minutes Marks for each station: 10 marks (as per competency check list and allotted marks) Total: 8×10 = 80 marks Oral exam = 20 marks Total = 100 marks On completion of procedural competencies in log book and clinical requirements, the NP student is qualified to appear for final practical examination. THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] Appendix-3 CLINICAL LOG BOOK FOR NURSE PRACTITIONER IN NEPHROLOGY NURSING (NPNepN) (Specific Procedural Competencies/Clinical Skills) Ist year +-------+--------------------------------------------+---------------+------+-----------------------------------+ |S.No. |Specific Competencies/Skills |No. performed |Date |Signature of the Preceptor*/Faculty| +-------+--------------------------------------------+---------------+------+-----------------------------------+ |I |RESEARCH APPLICATION AND EVIDENCE BASED PRACTICE| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1 |Preparation of research instrument | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2 |Writing systematic review/literature review | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3 |Preparation of a manuscript for publication (Ist or IInd year)| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4 |Research Project/EBP Project | | | | | |Topic: | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |II |LEADERSHIP, MANAGEMENT AND TEACHING | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1 |Preparation of staff patient assignment | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2 |Performance indicators and measures | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3 |Develop patient education aids | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4 |Patient care audit in the unit | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5 |Develop technology assisted education aid for nurses| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6 |Quality improvement audit | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7 |Microteaching - Staff nurses | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8 |Patient education and counseling | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |9 |Planning and conducting OSCE/OSPE | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |10 |Construction of tests | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |III |HEALTH ASSESSMENT | | | | | |Comprehensive history taking and clinical assessment| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.1 |Acute Kidney Injury | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.2 |Tubulointerstitial disease | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.3 |Chronic Kidney Disease | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.4 |Glomerular disease | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.5 |Nephrotic syndrome | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.6 |Fluid volume status | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.7 |Comprehensive system wise physical assessment| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2 |Age specific history & physical examination | | | | | |(Nephrology) | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.1 |Neonate | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.2 |Child | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.3 |Adult | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.4 |Geriatric | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.5 |Pregnant women | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |IV |DIAGNOSTIC PROCEDURES | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1 |Collecting blood sample for laboratory tests| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.1 |Biochemistry | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.2 |Clinical pathology | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.3 |Microbiology | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.4 |ABG | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2 |Assist/Perform | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.1 |Paracentesis | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.2 |Thoracentesis | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.3 |Lumbar puncture | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.5 |Renal biopsy | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.6 |Bone marrow aspiration | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.7 |Ultrasound kidneys | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.8 |Ultrasonographic assessment of access flow | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.9 |ECG and interpretation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.10 |ABG analysis and interpretation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3 |Observe procedures | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.1 |Renal Doppler | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +-------+--------------------------------------------+---------------+------+-----------------------------------+ |S.No. |Specific Competencies/Skills |No. performed |Date |Signature of the Preceptor*/Faculty| +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.2 |Fistulogram | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.3 |Drug assay | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.4 |MRI/CT | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.5 |Renal angiogram | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.6 |Pathological examination of kidney tissue | | | | | |(LM, IF, EM) | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.7 |Echocardiogram | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |V |COMPETENCIES IN NEPHROLOGY | | | | | |Drug administration and prescription in kidney| | | | | |disorders | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.1 |Antihypertensives | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.2 |Oral glucose lowering agents | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.3 |Sodium correction | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.4 |Potassium correction | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.5 |Inotropes | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.6 |Vitamin and mineral supplements | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.7 |Intravenous fluid administration | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.8 |Insulin dose adjustment | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2 |Nutritional Assessment & Management | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.1 |Perform nutritional assessment | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.2 |Plan therapeutic diet for patient with CKD | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.3 |Plan therapeutic diet for patient with diabetes| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.4 |Nasogastric tube insertion | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.5 |NG Feeding | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.6 |Total Parenteral Nutrition | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3 |Airway Management | | | | | |Non-invasive ventilation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.1 |Low flow variable performance devices: | | | | | |nasal catheters/cannulae/double nasal prongs,| | | | | |face mask, face mask with reservoir bags | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.2 |High flow fixed performance devices: | | | | | |Entrainment (Venturi) devices, CPAP, BiPAP | | | | | |Invasive ventilation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.3 |Setting of mechanical ventilators | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.4 |Care of patient on mechanical ventilator | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.5 |Insertion of endotracheal tube | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.6 |Removal of endotracheal tube | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.7 |Endotracheal suctioning | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.8 |Tracheostomy care | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.9 |Confirm the position of ET tube | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.10 |Chest physiotherapy | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.11 |Postural drainage | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4 |Use of equipment | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4.1 |Infusion pumps | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4.2 |Syringe pumps | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4.3 |Defibrillator | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5 |Life support and end of life care | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5.1 |BLS | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5.2 |ACLS | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5.3 |Grief counseling | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5.4 |Breaking bad news | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6 |Patient Education and Counseling | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6.1 |Slowing down the progress of CKD | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6.2 |Therapeutic diet in CKD | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6.3 |Diabetes management | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7 |Communication, Problem solving and Critical | | | | | |Thinking | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +-------+--------------------------------------------+---------------+------+-----------------------------------+ |S.No. |Specific Competencies/Skills |No. performed |Date |Signature of the Preceptor*/Faculty| +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7.1 |Clinical Scenarios simulations | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7.2 | | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8 |Monitoring and interpretation of critical parameters| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.1 |Arterial Blood Gas (ABG) | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.2 |Hemodynamics | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.3 |Electrocardiogram (ECG) | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.4 |Invasive BP monitoring | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.5 |Noninvasive BP monitoring | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.6 |Glasgow Coma Score | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.7 |Sedation Score | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.8 |Pain Score | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.9 |Braden Score | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.10 |Bowel sounds | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.11 |GRBS | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.12 |GFR Estimation and CKD staging | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.13 |Chest X-ray | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ *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. Preceptors/Faculty must ensure that the signature is given for each competency only after they reach level 3. • Level 3 Competency denotes that the NPNepN student is able to perform that competency without supervision. • Level 2 Competency denotes that the student is able to perform each competency with supervision. • Level 1 Competency denotes that the student is not able to perform that competency/skill even with supervision. Signature of the Program Coordinator/Faculty Signature of the HOD/Principal CLINICAL LOG BOOK FOR NURSE PRACTITIONER IN NEPHROLOGY NURSING (NPNepN) IInd year +-------+--------------------------------------------+---------------+------+-----------------------------------+ |S.No. |Specific Competencies/Skills |No. performed |Date |Signature of the Preceptor*/Faculty| +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1 |ADVANCED COMPETENCIES | | | | | |Hemodialysis | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.1 |Pre, Intra, Post dialysis assessment | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.2 |Assessment of CVC | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.3 |Assessment of AV Fistula | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.4 |CVC site care | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.5 |Dry Weight assessment - Clinical and bio-impedance| | | | | |method | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.6 |UF calculation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.7 |Programming machine and starting HD | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.8 |Closing HD | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.9 |Bicarb preparation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.10 |Estimating URR, Kt/V, Assess dialysis adequacy| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.11 |Prescribe routine investigations and follow up results| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.12 |HD prescription | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.13 |Heparin preparation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.14 |Drug reconciliation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.15 |Prescription of common drugs based on lab reports:| | | | | |Erythropoietin, Phosphorous binders, Calcium and| | | | | |Vitamin D supplements, Antihypertensives, OGLA| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.16 |Perform varied dialysis modalities | | | | | |a. SCUF | | | | | |b. Isolated UF | | | | | |c. SLED | | | | | |d. CRRT | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ THE GAZTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +-------+--------------------------------------------+---------------+------+-----------------------------------+ |S.No. |Specific Competencies/Skills |No. performed |Date |Signature of the Preceptor*/Faculty| +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.17 |Perform Plasmapheresis | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.18 |Calculate plasma volume for removal | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.19 |Insertion of CVC into femoral and jugular vein| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.20 |Identify and manage complications in HD | | | | | |a. Intradialytic hypotension | | | | | |b. Hemolysis | | | | | |c. Muscle cramps | | | | | |d. Air embolism | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.21 |Identify and manage CVC related complications| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |1.22 |Identify and manage AVF related complications| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2 |Peritoneal Dialysis | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.1 |Assess and select patients for PD | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.2 |Perform PET, Determine PD prescription | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.3 |Perform PD exchanges | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.4 |Collect PD Fluid for culture | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.5 |Identify and manage Exit site infection, Tunnel| | | | | |infection and peritonitis | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.6 |Administer intraperitoneal antibiotics | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.7 |Alter PD prescription based on clinical assessment and| | | | | |PET | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.8 |Assess Dialysis adequacy including Kt/V | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |2.9 |Identify and manage noninfectious complications of| | | | | |PD | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3 |Kidney Transplantation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.1 |Pretransplant work up and evaluation of donor and| | | | | |recipient | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.2 |Counseling and selection of patients for transplant| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.3 |Legal formalities and Documentation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.4 |Assist for donor nephrectomy | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.5 |Assist in Kidney Transplantation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.6 |Preoperative care - Donor & Recipient | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.7 |Post operative care - Donor & Recipient | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.8 |Deceased Donor registry | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.9 |Assessment of brain death | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.10 |Perfusion of renal blood vessels before transplantation| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.11 |Fluid Management following Kidney Transplant| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.12 |Identify and manage graft rejection | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.13 |Identify and manage transplant related infections| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.14 |Wound and drain care | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |3.15 |Assess and evaluate the graft function following| | | | | |transplant | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4 |Patient Education and Counseling | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4.1 |Management of vascular access | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4.2 |Kidney Replacement Therapy options | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4.3 |Prevention and Management of complications in PD| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |4.4 |Post Kidney transplantation care | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5 |Drug Administration and Prescription | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5.1 |Catecholamines (calculation, titration & | | | | | |administration) | | | | | |a. Adrenaline | | | | | |b. Noradrenaline | | | | | |c. Dopamine | | | | | |d. Dobutamine | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5.2 |Immunosuppressant Drugs in Nephrology | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ THE GAZTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +-------+--------------------------------------------+---------------+------+-----------------------------------+ |S.No. |Specific Competencies/Skills |No. performed |Date |Signature of the Preceptor*/Faculty| +-------+--------------------------------------------+---------------+------+-----------------------------------+ |a |Induction agents | | | | | |Polyclonal antibodies (ATG) | | | | | |Interleukin 2 receptor antagonists (Basiliximab)| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |b |Maintenance Therapy | | | | | |Calcineurin inhibitors (Cyclosporin, Tacrolimus)| | | | | |mTOR inhibitors (Sirolimus, Everolimus) | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |c |Antiproliferative agents | | | | | |(Azathioprine, Mycophenolic acid) | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |d |Corticosteroids (Prednisolone) | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |e |Treatment for rejection | | | | | |Corticosteroids, ATG, IVIG | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |5.3 |Erythropoietin injection and dose adjustment| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6 |Infection Control Practices | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6.1 |Standard Precautions | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6.2 |Infection control protocols in HD unit | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6.3 |Infection control protocols in PD unit | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |6.4 |Infection control practices in Renal Transplant Unit| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7 |Quality Assurance/Improvement | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7.1 |Capture and present performance indicators measures| | | | | |in Dialysis unit | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7.2 |Microbiology surveillance in HD unit, RTU | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7.3 |Water quality management | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |7.4 |Quality improvement Audit | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8 |Management of Cardiovascular Alterations | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.1 |Intravenous fluid administration (Colloid/Crystalloid)| | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.2 |Blood and blood product administration | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.3 |Application of TED stocking | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |8.6 |Blood collection from arterial line | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |9 |Management of Neurological Alterations | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |9.1 |Sensory stimulation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |9.2 |Consciousness/Coma status monitoring | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |9.3 |Brain death evaluation | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |10 |Ordering Investigations | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |10.1 |ECG | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |10.2 |ABG | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |10.3 |Chest X ray | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |10.4 |Ultrasound | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |10.5 |Basic biochemistry investigations | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |10.6 |Basic microbiology investigations | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11 |Ordering Procedures/Treatment | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.1 |Nebulization | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.2 |Chest physiotherapy | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.3 |Hemodialysis | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.4 |Insertion and removal of urinary catheter | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.5 |SCUF | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.6 |TEDS | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.7 |Isolated UF | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.8 |SLED | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.9 |First HD protocol | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ |11.10 |Therapeutic diet | | | | +-------+--------------------------------------------+---------------+------+-----------------------------------+ *When the student is found competent to perform the skill, it will be signed by the preceptor. Students: Students are expected to perform the listed skills/competencies many times until they reach level 3 competency, after which the preceptor signs against each competency. Preceptors/Faculty: Must ensure that the signature is given for each competency only after they reach level 3. THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] • Level 3 Competency denotes that the NPNepN student is able to perform that competency without supervision. • Level 2 Competency denotes that the student is able to perform each competency with supervision. • Level 1 Competency denotes that the student is not able to perform that competency/skill even with supervision. Note: 5-10% of procedures that are rare should be practiced in skill lab and attained level 3 competency. Signature of the Program Coordinator/Faculty Signature of the HOD/Principal Appendix-4 CLINICAL REQUIREMENTS FOR NURSE PRACTITIONER IN NEPHROLOGY NURSING (NPNepN) Ist year +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |S.No. |Clinical Requirement |Date |Signature of the Preceptor/Faculty| +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1 |Clinical Seminar/Journal Club/Clinical Conference | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1.1 |*APN - Clinical pathway in specific clinical condition/ Application of | | | | |specific nursing theory (Clinical Seminar) | | | | |Title of the topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1.2 |*RA - Evidence search for nephrology nursing competencies (Clinical | | | | |Conference/Journal Club) | | | | |Title of the topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1.3 |*L,M&T - Trends in Leadership/Management/Teaching | | | | |(Journal Club) | | | | |Title of the topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2 |Clinical Rounds (with Nursing Staff, Faculty, Students) - | | | | |Case/Clinical Presentation | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.1 |Pathophysiology (Clinical Presentation) | | | | |Name of clinical condition: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.2 |Pathophysiology (Clinical Presentation) | | | | |Case Study (Written Report) | | | | |Name of clinical condition: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3 |Pharmacology - Drug Studies | | | | |(Drugs listed under Standing Orders) - | | | | |Written report of 5 presentations (Bedside Presentations) | | | | |Drug name: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.1 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.2 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.3 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.4 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.5 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.6 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.7 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.8 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.9 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3.10 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3 |Interdisciplinary Clinical Rounds (with Doctors) - | | | | |Case/Clinical Presentation | | | | |(Written reports are for submission) | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.1 |Health Assessment (Adult) - History & Physical Examination (Two | | | | |written reports) | | | | |3.1.1. | | | | |3.1.2. | | | | |3.1.3. | | | | |3.1.4. | | | | |3.1.5. | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.2 |Health Assessment (Pediatric) - History & Physical Examination | | | | |(One written report) | | | | |3.2.1. | | | | |3.2.2. | | | | |3.2.3. | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |S.No. |Clinical Requirement |Date |Signature of the Preceptor/Faculty| +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.3 |Health Assessment (Pregnant Woman) (One written report) | | | | |3.3.1. | | | | |3.3.2. | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ *Advanced Practice Nursing - APN; Research Application - RA, Leadership, Management and Teaching - L,M&T Signature of the Program Coordinator/Faculty Signature of the HOD/Principal CLINICAL EXPERIENCE DETAILS +--------------------------+-------------------+-----------------+-----------------------------------+ |Name of Clinical Area |Clinical Condition |No. of days |Signature of | | | |care given |Faculty/Preceptor | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ Signature of the Program Coordinator/Faculty Signature of the HOD/Principal CLINICAL REQUIREMENTS FOR NURSE PRACTITIONER IN NEPHROLOGY NURSING (NPNepN) IInd year +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |S.No. |Clinical Requirement |Date |Signature of the Preceptor/Faculty| +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1 |Clinical Seminar/Journal Club/Clinical Conference | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1.1 |Foundations of Nephrology Nursing Practice | | | | |(Clinical Conference) | | | | |Title of the topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1.2 |Nephrology Nursing I (Clinical Seminar) | | | | |Title of the topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1.3 |Nephrology Nursing I (Journal Club) | | | | |Title of the topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1.4 |Nephrology Nursing II (Clinical Seminar) | | | | |Title of the topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |1.5 |Nephrology Nursing II (Journal Club) | | | | |Title of the topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2 |Clinical Rounds (with Nursing Staff, Faculty, Students) - | | | | |Clinical/Case Presentation | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |S.No. |Clinical Requirement |Date |Signature of the Preceptor/Faculty| +-------+---------------------------------------------------------------------------+------+-----------------------------------+ | |(Written reports are for submission) | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.1 |Foundations of Nephrology Nursing | | | | |(Family Education/Counseling) - Written Report | | | | |Name of topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.2 |Foundations of Nephrology Nursing (Clinical/Care Pathway) | | | | |Name of topic: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.3 |Nephrology Nursing I (Clinical Presentation) | | | | |Name of clinical condition: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.4 |Nephrology Nursing I (Case Study Report) | | | | |Name of clinical condition: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.5 |Nephrology Nursing II (Clinical Presentation) | | | | |Name of clinical condition: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.6 |Nephrology Nursing II (Case Study Report) | | | | |Name of clinical condition: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.7 |Drug Studies (drugs listed under Standing Orders) | | | | |Bedside Presentation (Five written reports) | | | | |Name of drug: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.8 |Name of drug: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.9 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.10 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.11 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.12 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.13 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.14 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.15 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |2.16 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3 |Interdisciplinary Clinical Rounds (with ICU Doctors) - Clinical/Case | | | | |Presentation | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.1 |Nephrology Nursing I | | | | |Name of clinical condition: | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.2 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.3 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.4 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.5 |(Case Study Report) | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.6 |Nephrology Nursing II | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.7 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.8 | | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.9 |(Case Study Report) | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ |3.10 |Written Report (Developed Clinical/Care Pathway) | | | +-------+---------------------------------------------------------------------------+------+-----------------------------------+ Note: Clinical presentation can be written for case study report. Signature of the Program Coordinator/Faculty Signature of the HOD/Principal CLINICAL EXPERIENCE DETAILS +--------------------------+-------------------+-----------------+-----------------------------------+ |Name of Clinical Area |Clinical Condition |No. of days |Signature of | | | |care given |Faculty/Preceptor | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ | | | | | +--------------------------+-------------------+-----------------+-----------------------------------+ Signature of the Program Coordinator/Faculty Signature of the HOD/Principal Appendix-5 STANDING ORDERS AND PROTOCOLS Nurse Practitioners in Nephrology Nursing are prepared and qualified to assume responsibility and accountability for the care of patients with nephrology conditions. They collaborate with physicians, surgeons and specialists to ensure accurate therapy for patients with high acuity needs. On completion of the program, the Nurse Practitioners will be permitted to administer drugs listed in standing orders as per the institutional standing orders. They will also be permitted to order diagnostic tests/procedures and therapies as per institutional protocols. STANDING ORDERS The following intravenous injections or infusions may be administered by the Nurse Practitioner during emergency in nephrology ward/Dialysis unit or renal transplant Unit without a written order. Catecholamines 1. Adrenaline 2. Noradrenaline 3. Dopamine 4. Dobutamine Antidysrhythmic 5. Adenosine 6. Amiodarone 7. Lidocaine/Xylocard Adrenergic agent 8. Ephedrine Antihistamine 9. Avil Antihypertensives Corticosteroid 10. Hydrocortisone 11. Dexamethasone Antiepileptic 12. Levetiracetam 13. Phenytoin 14. Propofol Electrolytes & acid base, fluid correction agents 15. Soda bicarbonate 8.4% 16. Soda bicarbonate 7.5% 17. Magnesium sulphate 18. Potassium chloride THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4] 19. IV Fluids - NS, DNS, 5% Dextrose The following investigations and therapies may be ordered by the Nurse Practitioners +-------------------------------------------------+-------------------------------------------------+ |Ordering Investigations |Ordering Therapies | +-------------------------------------------------+-------------------------------------------------+ |• ECG |• Nebulization | +-------------------------------------------------+-------------------------------------------------+ |• ABG |• Chest physiotherapy | +-------------------------------------------------+-------------------------------------------------+ |• Chest X ray |• Insertion and removal of urinary catheter for female patients| +-------------------------------------------------+-------------------------------------------------+ |• Basic Biochemistry investigations - |• TEDS | | Hb, PCV, TIBC, WBC Total, WBC |• Surgical dressing | | differentials, ESR, electrolytes, |• Starting and closing dialysis | | platelets, PT, aPTT, bleeding and |• Application of ichthammol glycerin/magnesium sulphate dressing for| | clotting time, procalcitonin, D-dimer, | thrombophlebitis/extravasation | | creatinine, HbA1c, AC, PC, HDL, |• Pin site care for patients on external fixators| | LDL, TIG, cholesterol total, HIV, |• Isometric and isotonic exercises | | HbsAg, HCV |• Hot and cold applications | +-------------------------------------------------+-------------------------------------------------+ |• Basic Microbiology investigations - |• Hot and cold supplements | | blood and urine samples for culture |• Removal of CVC, Culture from CVC and PD catheter site| | and sensitivity, tips of vascular |• Peritoneal equilibration test | | access, sample from CVC site, PD |• Heparin infusion in HD | | catheter exit site |• Erythropoietin injections | +-------------------------------------------------+-------------------------------------------------+ 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 NPNepN 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 NPNepN students. Dr. T. DILEEP KUMAR, President [ADVT.-III/4/Exty./901/2024-25] Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.