Full Text
REGD. No. D. L.-33004/99
The Gazette of India
CG-DL-E-29102024-258233
EXTRAORDINARY
PART III—Section 4
PUBLISHED BY AUTHORITY
No. 842]
NEW DELHI, MONDAY, OCTOBER 21, 2024/ASVINA 29, 1946
INDIAN NURSING COUNCIL
NOTIFICATION
New Delhi, the 7th October, 2024
INDIAN NURSING COUNCIL {NURSE PRACTITIONER IN GERIATRIC NURSING (NPGN) -
POSTGRADUATE RESIDENCY PROGRAM} REGULATIONS, 2023
F.No. 11-1/2024-INC (IV). 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 Geriatric Nursing
(NPGN) - Postgraduate Residency Program} Regulations, 2023.
ii. These shall come into force on the date of notification of the same in the Official Gazette of India.
2. DEFINITIONS
In these Regulations, unless the context otherwise requires,
i. 'the Act' means the Indian Nursing Council Act, 1947 (XLVIII of 1947) as amended from time to time;
ii. 'the Council' means the Indian Nursing Council constituted under the Act;
iii. 'SNRC' means the State Nurse and Midwives Registration Council, by whichever name constituted, by the
respective State Governments;
iv. 'RN & RM' means a Registered Nurse and Registered Midwife (RN & RM) and denotes a nurse who has
completed successfully, recognised Bachelor of Nursing (B.Sc. Nursing) or Diploma in General Nursing and
Midwifery (GNM) course, as prescribed by the Council and is registered in a SNRC as Registered Nurse and
Registered Midwife;
v. 'Nurses Registration & Tracking System (NRTS)' means a system developed by the Council and software
developed in association with National Informatics Centre (NIC), Government of India, and hosted by NIC
for the purpose of maintenance and operation of the Indian Nurses Register. It has standardised forms for
collection of the data of Registered Nurse and Registered Midwife (RN & RM)/ Registered Auxiliary Nurse
Midwife (RANM)/Registered Lady Health Visitor (RLHV) upon Aadhar based biometric authentication;
vi. 'NUID' is the Nurses Unique Identification Number given to the registrants in the NRTS system;
vii. 'General Nursing and Midwifery (GNM)' means Diploma in General Nursing and Midwifery qualification
recognized by the Council under Section 10 of the Act and included in Part-I of the Schedule of the Act.
NURSE PRACTITIONER IN GERIATRIC NURSING (NPGN) -
POSTGRADUATE RESIDENCY PROGRAM
I. Introduction and Background
There is a rise in life expectancy of an adult in the world as per the WHO data base (2022). This rise in older
population increases the burden of disease and disability, and poses a tremendous challenge to the health sector as
well as to the social and economic infrastructure. National Health Policy (2017), National Population Policy (2015))
and National Program for Health Care of the Older Adults (2014) have emphasized the need for provision of quality
and specialized health care of the older population. NHP (2017) emphasizes on significant expansion in tertiary care
services both in public and private health sectors. In building capacity, the health care professionals require advanced
educational preparation to support specialized and super-specialized healthcare services. Nurse Practitioners (NPs)
will be able to meet this demand provided they are well trained and empowered to practice through critical thinking,
judgement, and skill. Rigorous educational preparation will enable them to assess and participate in promoting health,
health maintenance, health restoration, rehabilitation and palliative care for older adult patients with chronic and
critical illnesses. The role of NPGN was established in Unites States in 1975, and then introduced in Australia, Israel,
Norway and other countries.
A curricular structure/framework is proposed by the Council towards preparation of Nurse Practitioner in
Geriatric Nursing (NPGN) at the Master's Level. The special feature of this program is that it is a clinical residency
program emphasizing a strong clinical component with 15% of theoretical instruction and 85% of practicum.
Competency based training is the major approach and NP education is based on competencies adapted from
International Council of Nurses (ICN, 2005) and the NONPF competencies (2017). NPGN education and training is
based on competencies adapted from AACN, 2017. Every course is based on achievement of competencies. The
NPGN program consists of various courses of study that are based on strong scientific foundations including
evidenced based practice and the management of complex health systems. These are built upon the theoretical and
practice competencies of B.Sc. trained nurses.
The NPGN program is intended to prepare registered B.Sc. nurses to provide advanced nursing care to older
patients in hospital and community settings. The nursing care is focused on stabilizing patients' condition, minimizing
acute complications and maximizing restoration of health. The practice settings for NPGN include hospital outpatient
clinics and in-patient facilities and long-term care facilities and they focus mainly on primary and secondary care.
These NPs are required to practice in geriatric care units of tertiary care centres too. The NPGN would be equipped to
diagnose, treat and manage chronic and acute conditions and geriatric symptoms associated with ageing and provide
therapeutic interventions or, at times, palliative treatments and end of life care. They receive advanced education to
provide services that address the health issues that impact older adults, as well as on the resultant cognitive, physical,
psychological and social impairments.
On completion of the program and registration with respective SNRC, they are permitted to practice all
competencies listed in the logbook of the Council syllabus and also independently administer drugs and order
diagnostic tests, procedures, medical equipment and therapies as per institutional protocols/standing orders. The
NPGN when exercising this authority, they are accountable for the competencies in
a) Using scientific knowledge and theoretical foundations in ageing;
b) Patient selection/admission into geriatric unit and discharge;
c) Problem identification through appropriate assessment;
d) Selection/administration of medication or devices or therapies;
e) Patient education for use of therapeutics;
f) Knowledge of drug interactions of therapeutics;
g) Evaluation of outcomes;
h) Recognition and management of complications and untoward reactions;
i) Contribution towards evidence-based innovations in geriatric clinical practice;
j) Providing guidance, consultation, mentorship and educational experiences to students, nurses and other
health professionals regarding acute and primary care;
k) Participation in national health programs in geriatric care effectively.
The NPGN is prepared and qualified to assume responsibility and accountability for the holistic care of older
adults under his/her care. This has necessitated retention of "domains of learning" under "competencies". With
establishment of new cadre at the central and state level, NPGN will be able to provide cost effective, competent, safe
and quality driven specialized nursing care to older adult patients in a variety of settings such as geriatric wards,
outpatient department, geriatric day care services, psycho geriatric ward, community geriatric and geriatric
rehabilitation wards.
The said postgraduate degree will be registered as an additional qualification by the SNRC.
Philosophy
The Council believes that there is a great need to establish a postgraduate program titled Nurse Practitioner in
Geriatric Nursing (NPGN) to meet the challenges and demands of primary and tertiary health care services in India
and to provide quality care to older adult patients and their families.
The Council believes that the postgraduates from a residency program focused on strong clinical component and
competency-based training must be able to demonstrate clinical competence based on sound theoretical and evidence-
based knowledge. The teaching learning approach should focus on adult learning principles, code of ethics,
competency-based education, collaborative learning, precepted clinical learning with medical and nursing preceptors,
experiential learning, and self-directed learning. Education providers/preceptors/mentors must update their current
knowledge and practices. Medical faculty are invited to participate as preceptors in the training.
The Council also believes that a variety of educational strategies can be used in the clinical settings to address the
deficit of qualified geriatric nursing faculty. It is hoped to facilitate developing policies towards registration/ licensure
and create cadre positions for appropriate placement of these postgraduate NPs in Geriatric Nursing to function in
primary and acute care centres.
The Council believes that values, ethics and beliefs and motivation would achieve competencies in patient and
family centred care, process-oriented care, self-care and continuing professional development utilizing evidence-based
practice that are essential to achieve quality outcomes.
An educational framework for the NP curriculum is proposed (See Figure-1).
Strong
Clinical
Component
(Clinical Residency)
Theory-15%
1. Core Courses
• Theoretical Basis for
Advanced Practice Nursing
• Research Application and Evidence
Based Practice in Geriatric Care
• Advanced Skills in Leadership,
Management and Teaching
Advanced
Pathophysiology
applied to
Geriatric Nursing
• Advanced
Pharmacology
applied to
Geriatric Nursing
• Advanced
Health/Physical
Assessment
• Foundations
of Geriatric
Nursing
Practice
• Geriatric
Nursing - I
• Geriatric
Nursing - II
NP IN
GERIATRIC
NURSING
PROGRAM
Specialty Courses
III. Advanced Practice Courses
Competency Based
Education and
Training
Practicum - 85%
Advanced
Knowledge
and Ethics
Registered B.Sc. Nurse with 1-year Clinical Experience preferably in Geriatric Care Setting
(Entry requirement)
Figure-1. Nurse Practitioner in Geriatric Care - An Educational Curricular Framework
II. Program Description
This program is designed to assist students in developing expertise and in-depth understanding in the field of
Geriatric Nursing. It will help students to develop advanced nursing skills in Geriatric Nursing.
The NPGN program is a nursing residency program with a main focus on competency-based training. The
duration of the course is of two years with the curriculum consisting of theory that includes core courses, advanced
practice courses and clinical courses, besides clinical practicum which is a major component (Refer Curricular
Framework).
III. Aim
The NPGN program prepares registered B.Sc. nurses for advanced practice roles such as clinical experts,
managers, educators, and consultants as Nurse Practitioners in Geriatric Nursing leading to M.Sc. Nursing (NP in
Geriatric Nursing).
The aim of this curriculum is to create a cadre of nursing professionals in the care of the older adults who would
acquire knowledge about the age-related biological changes.
IV. Objectives
On completion of the program, the NPGNs will be able to:
1. Assume responsibility and accountability to provide competent and appropriate family centred care to older
adult patients;
2. Demonstrate clinical competence/expertise in providing geriatric care which includes assessment, diagnostic
reasoning, complex monitoring and therapies;
3. Apply theoretical, pathophysiological, and pharmacological principles and evidence base in implementing
therapies/interventions in geriatric care;
4. Assess and participate in managing acute illnesses in older adults to stabilize and restore the patient's health
and minimize or manage complications as part of geriatric multidisciplinary team;
5. Collaborate with other health care professionals in the geriatric care team, across the continuum of care.
V. Minimum requirements to start the Nurse Practitioner in Geriatric Nursing (NPGN) Program
The institution must accept the accountability for the NPGN program and its students and offer the program
congruent with the Council standards. It must fulfil the following requirements:
1. Essentiality Certificate
a. Any institution who wishes to start Nurse Practitioner in Geriatric Nursing 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. Beds
a. The hospital should have a minimum of 30 bedded geriatric ward with supportive services such as
orthopaedics, neurology, physiotherapy, occupational therapy department, ophthalmology, gynaecology,
dentistry, rheumatology, psychiatry, rehabilitative and community health services;
4. Affiliation with Old Age Homes
a. The hospital can have affiliation to old age homes.
5. Staffing for Geriatric Unit
a. Every geriatric ward should have a Charge Nurse preferably with B.Sc. Nursing or M.Sc. Nursing
qualification;
b. The nurse patient ratio should be 1:4 as per the Council norms;
с. Provision of additional 45% staff towards leave reserve;
d. The geriatric unit must have a geriatric physician, social worker/counsellor, physiotherapist and an
occupational therapist;
e. Doctor patient ratio can be 1:10.
6. Faculty/Staff Resources
a. Clinical area:
i. Nursing Preceptor: Full time qualified GNM with 6 years of experience, preferably qualified in Post
Basic Diploma in Geriatric Nursing or B.Sc. Nursing with 2 years' experience or M.Sc. (Medical
Surgical Nursing/Community Health Nursing) with one year of experience, in a geriatric unit;
ii. Medical Preceptor: MD in Geriatric/General Medicine;
iii. Preceptor Student Ratio: Nursing 1:10, Medical 1:10 (Every student must have a medical and a nursing
preceptor).
b. Teaching faculty:
i. Professor/Associate Professor: 1 {Teaching experience: 5 years post PG-M.Sc. (Medical Surgical
Nursing/Community Health Nursing)} - One faculty for every 10 students;
ii. Assistant Professor: 1 (Teaching experience: 3 years post B.Sc. Nursing).
с. The above faculty shall perform dual role or be a senior nurse with M.Sc. Nursing qualification employed in
geriatric unit.
d. Guest lecturers: Pharmacology, Pathophysiology, Geriatric Medicine, General Medicine and General
Surgery, Cardiology, Orthopaedics, Psychiatry, Community Medicine, Physiotherapy and occupational
therapy.
7. Physical and Learning Resources at Hospital/College
a. One class room/conference room in the clinical area;
b. Skills lab for simulated learning (hospital/college);
с. Library and computer facilities with access to online journals;
d. E-learning facilities.
8. List of equipment for a thirty bedded geriatric ward (See Appendix-1).
9. Student Recruitment/Admission Requirements
a. Applicants must have a registered B.Sc. Nursing/P.B.B.Sc. Nursing degree with a minimum of one-year
clinical experience, preferably in any general medical-surgical/geriatric care setting prior to enrolment;
b. Must have undergone B.Sc. Nursing in an institution recognized by the Council and have been registered by
the respective SNRC;
с. Must have scored not less than 55% aggregate marks in the B.Sc. Nursing program;
d. Selection must be based on the merit of an entrance examination and interview held by the competent
authority;
e. Must be physically fit.
Number of candidates: 1 candidate for 10 geriatric beds.
Salary:
1. In-service candidates will get regular salary.
2. Stipend/Salary for the other candidates as per the salary structure of the hospital where the course is
conducted.
VI. Examination Regulations
Eligibility for appearing in 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 the 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 Refer OSCE Guidelines found in
Appendix-2.
Maximum number of students per day = 10 students.
Examination should be held in the 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 NPGN program/M.Sc. Nursing faculty (Medical Surgical Nursing preferable) with 5 years
of Post PG experience}, one external examiner (same as above) and one medical internal examiner who should have
served as the preceptor for NPGN program.
Dissertation
Research Guides: Main guide: Nursing faculty (3 years Post PG experience) teaching NP 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 geriatric nursing that will add knowledge or evidence for nursing
intervention. The research should be conducted in any of the geriatric 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).
VII. Assessment (Formative and Summative)
• Test paper, quiz, seminar
• Written assignments/Term papers
• Case/Clinical presentation
• Clinical or Care pathway/Case study report
• Clinical performance assessment
• Objective Structured Clinical Examination (OSCE)
• Final examination
(See Appendix-2 for Assessment Guidelines)
Scheme of Final Examination
+----------+-------------------------------------------------------------+--------------------------------------------------+
| S.No. | Title | Theory % |
| | +----------+----------+----------+----------+----------+
| | | Hours | Internal | External | Hours | Internal |
| | | | | | | |
+==========+=============================================================+==========+==========+==========+==========+==========+
| | Ist year | | | | | |
| | Core Courses | | | | | |
| 1 | Theoretical Basis for Advanced Practice Nursing | 2 hours | 50 | | | |
| 2 | Research Application and Evidence Based Practice in Geriatric | 3 hours | 30 | 70 | | |
| | Care | | | | | |
| 3 | Advanced Skills in Leadership, Management and Teaching | 3 hours | 30 | 70 | | |
| | Advanced Practice Courses | | | | | |
| 4 | Advanced Pathophysiology & Advanced Pharmacology applied to | 3 hours | 30 | 70 | | |
| | Geriatric Nursing | | | | | |
| 5 | Advanced Health/Physical Assessment | 3 hours | 30 | 70 | 50 | 50 |
| | IInd year | | | | | |
| | Specialty Courses | | | | | |
| 1 | Foundations of Geriatric Nursing Practice | 3 hours | 30 | 70 | 100 | 100 |
| 2 | Geriatric Nursing - I | 3 hours | 30 | 70 | 100 | 100 |
| 3 | Geriatric Nursing - II | 3 hours | 30 | 70 | 100 | 100 |
| 4 | Dissertation and viva | | | | | 50 |
+----------+-------------------------------------------------------------+----------+----------+----------+----------+----------+
VIII. Courses of Instruction
+----------+-------------------------------------------------+--------------+---------------------+-----------------+
| S.No. | Title | Theory (hours) | Lab/Skill Lab (hours) | Clinical (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 Geriatric Care | | | |
| III | Advanced Skills in Leadership, Management and | 56 | 24 | 192 (4 weeks) |
| | Teaching Skills | | | |
| IV | Advanced Practice Courses | | | |
| | Advanced Pathophysiology applied to Geriatric | 60 | | 336 (7 weeks) |
| | Nursing | | | |
| V | Advanced Pharmacology applied to Geriatric | 54 | | 336 (7 weeks) |
| | Nursing | | | |
| VI | Advanced Health/Physical Assessment | 70 | 48 | 576 (12 weeks) |
| | TOTAL = 2208 hours | 336 (7 weeks) | 96 (2 weeks) | 1776 (37 weeks) |
| | IInd year | | | |
| | Specialty Courses | | | |
| VII | Foundations of Geriatric Nursing Practice | 96 | 48 | 576 (12 weeks) |
| VIII | Geriatric Nursing - I | 96 | 48 | 576 (12 weeks) |
| IX | Geriatric Nursing - II | 96 | 48 | 624 (13 weeks) |
| | TOTAL = 2208 hours | 288 (6 weeks) | 144 (3 weeks) | 1776 (37 weeks) |
+----------+-------------------------------------------------+--------------+---------------------+-----------------+
Number of weeks available in a year = 52 - 6 (Annual leave, Casual leave, Sick leave = 6 weeks) = 46 weeks × 48
hours = 2208 hours
Two years = 4416 hours (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-Skill Lab-Clinical) {Theory = 15%, Practicum (Skill Lab & Clinical) = 85%}
IInd year: 288-144-1776 hours (Theory-Skill Lab-Clinical) {Theory = 15%, Practicum (Skill Lab & Clinical) = 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 one per week.
Clinical placements
Ist year: 44 weeks (excludes 2 weeks of introductory block classes and workshop)
Geriatric wards - 12 weeks
General medical wards - 6 weeks
General surgical wards - 2 weeks
Orthopaedic ward - 4 weeks
Ophthalmology ward - 1 week
Neurology ward and OPD - 3 weeks
Psychiatric ward - 3 weeks
Community field practice area - 3 weeks
Emergency department - 1 week
Outpatient Department
Geriatric OPD - 4 weeks
Psychiatric OPD - 1 week
Endocrine OPD - 2 weeks
Physiotherapy and Occupational therapy - 2 weeks
IInd year : 45 weeks (excludes one week of block classes)
Geriatric ward 12 weeks
Medical ICU - 3 weeks
Surgical ICU - 3 weeks
Rehabilitation unit - 5 weeks
Palliative and hospice centre - 4 weeks
Old age home - 4 weeks
Haematology and Oncology ward - 1 week
Urology ward - 1 week
Psychogeriatric ward/dementia - 2 weeks
Community field practice area - 3 weeks
Emergency department - 1 week
Outpatient Department
Geriatric OPD and dementia clinic - 2 weeks
Gynae Oncology OPD - 1 week
Geriatric day care centre - 1 week
Podiatric OPD - 1 week
Field visits
Hospice care - 1 week
Palliative care unit
Old age homes
C. Teaching methods: Teaching - Theoretical, Lab & Clinical can be done in the following way and integrated
during clinical posting:
• Experiential learning
• Reflective learning
• Simulation
• Clinical seminars
• Clinical conference
• Case/clinical presentation
• In depth drug study, presentation and report
• Nursing rounds
• Journal clubs
• Case study
• Advanced health assessment
• Faculty lecture
• Directed reading
• Assignments
• Workshops
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.
E. Nurse Practitioner in Geriatric Care Competencies (Adapted from AACN, 2017)
Nurse Practitioner in Geriatric Nursing (NPGN)
1. Contributes to knowledge development and improved care of the geriatric population.
2. Develops the ability to obtain a relevant focused history.
3. Demonstrates the ability to appropriately diagnose, evaluate and prescribe treatment and preventive strategies
for older adults.
4. Develops ability to manage/control infection in patients including risk of cross infection.
5. Works effectively with teams to ensure quality and safety of patient care.
6. Demonstrates ability to perform a comprehensive geriatric assessment.
7. Demonstrates ability to assess the nutritional status of older adult and appropriate nutritional support strategy.
8. Describes the current and evolving role of NP in geriatric acute care.
9. Provides guidance, consultation, mentorship and educational experiences to students, nurses and other health
professionals about the care of geriatric population.
10. Provides leadership to facilitate the highly complex coordination and planning required for the delivery of
care to young adults (including late adolescents), adults, and older adults.
11. Implements evidence-based practice interventions to promote safety and risk reduction for older adults with
acute, critical, and complex chronic illness needs.
12. Demonstrates continuous quality improvement of one's own practice.
13. Analyses strengths and barriers of technological and information systems with the goal of improving care
delivery and coordination.
14. Applies ethical and legal standards in health care for the geriatric population.
15. Identifies the important concepts of Pathophysiology of common diseases of older adults.
16. Provides effective care and excels in clinical skills in geriatric care.
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 | Workshop | Theory integrated in Clinical Practicum | Methods of Teaching |
| | | Classes | | | (Topic can be specified) |
+==========+=================================================+=================+===========+==============================================+=====================================+
| 1 | Theoretical Basis for Advanced Practice Nursing | 8 hours | | 1 x 32 = 32 hours | • Seminar/Theory application |
| | (40) | | | | • Lecture (faculty) |
| 2 | Research Application and Evidence Based Practice| 8 hours | 40 (5 days) | 1 × 24 = 24 hours | • Research study analysis |
| | in Geriatric Care (56+24) | | + 8 hours | | • Exercise/Assignment (lab) |
| | | | | 2.5 × 16 = 40 hours | |
| 3 | Advanced Skills in Leadership, Management and | 12 + 2 hours | | 1 × 26 = 26 hours | • Clinical conference |
| | Teaching (56 + 24) | | | | • Seminar |
| | | | | | • Exercises/Assignment (lab) |
| 4 | Advanced Pathophysiology applied to Geriatric | | | 1.5 × 40 = 60 hours | • Case presentation |
| | Nursing (60) | | | | • Seminar |
| | | | | | • Clinical conference |
| 5 | Advanced Pharmacology applied to Geriatric | 10 hours | | 1 × 44 = 44 hours | • Nursing rounds |
| | Nursing (54) | | | | • Drug study presentation |
| | | | | | • Standing orders/presentation |
| 6 | Advanced Health/Physical Assessment (70+48) | 8 hours | | 2 x 26 = 52 hours | • Clinical demonstration (faculty) |
| | | | | 1.5 x 18 = 27 hours | • Return demonstration |
| | | | | 1 x 15 = 15 hours | • Nursing rounds |
| | | | | 2 x 6 = 12 hours | • Physical assessment (all systems) |
| | | | | 2 × 2 = 4 hours | • 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
+----------+---------------------------------------------+---------------------------------------+---------------------------------------+
| | 1 week Block classes (48 hours) | Theory integrated into Clinical Practicum | Methods of Teaching |
+==========+=============================================+=======================================+=======================================+
| 1 | Foundations of Geriatric Nursing Practice | 9 hours × 11 weeks = 99 hours | • Demonstration (lab) |
| | (96 + 48 hours) = 144 hours | | • Return demonstration (lab) |
| | | | • Clinical teaching |
| | | | • Case study |
| | | | • Seminar |
| | | | • Clinical conference |
| | | | • Faculty lecture |
| 2 | Geriatric Nursing - I | 9 hours × 16 weeks = 144 hours | • Demonstration (lab) |
| | (96 + 48 hours) = 144 hours | | • Return Demonstration (lab) |
| | | | • Clinical conference/journal club |
+----------+---------------------------------------------+---------------------------------------+---------------------------------------+
+----------+---------------------------------------------+---------------------------------------+---------------------------------------+
| | Ist year Courses | Introductory | Workshop | Theory integrated in Clinical Practicum | Methods of Teaching |
| | | Classes | | | (Topic can be specified) |
+==========+=============================================+=======================================+==========+=========================================+=====================================+
| 3 | Geriatric Nursing - II | | | 9 hours × 16 weeks = 144 hours | • Seminar |
| | (96 + 48 hours) = 144 hours | | | | • Case presentation |
| | | | | | • Drug study (including drug interaction)|
| | | | | | • Nursing rounds |
| | | | | | • Faculty lecture |
| | | | | | • Demonstration (lab) |
| | | | | | • Return Demonstration |
| | | | | | • Nursing rounds |
| | | | | | • Clinical conference/journal club |
| | | | | | • Seminar |
| | | | | | • Faculty lecture |
+----------+---------------------------------------------+---------------------------------------+----------+-----------------------------------------+-------------------------------------+
IInd year: Block classes - 1 week, 45 weeks - 8.5/9 hours per week (382.5/384 hours).
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.
3. Develops in depth understanding of the healthcare delivery system in India, and its challenges.
4. Applies economic principles relevant to delivery of geriatric care services.
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 by involving all healthcare team members in geriatric care and
perform the roles within the authorized scope of practice.
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 geriatric patients.
11. Predicts future challenges of Nurse Practitioner's roles in a variety of healthcare settings.
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 | 2 |
| | Policy (Competency-2) | |
| 4. | Health Economics & Health Care Financing (Competency-4) | 4 |
| 5. | Health Information System including Nursing Informatics (use| 4 |
| | of computers) (Competency-5) | |
| | ADVANCED NURSING PRACTICE (ANP) | |
| 6. | ANP - Definition, Scope, Philosophy, Accountability, Roles &| 3 |
| | Responsibilities (Collaborative Practice and Nurse | |
| | Prescribing Roles) (Competency-6 & 7) | |
| 7. | Regulation (Accreditation of Training Institutions and | 3 |
| | Credentialing) & Ethical Dimensions of Advanced Nursing | |
| | Practice Role (Competency-8) | |
| 8. | Nurse Practitioner - Roles, Types, Competencies, Clinical | 3 |
| | Settings for Practice, Cultural Competence (Competency-6) | |
| 9. | Training for NPs - Preceptorship (Competency-9) | 2 |
| 10. | Future Challenges of NP Practice (Competency-11) | 4 |
| 11. | Theories of Nursing applied to APN (Competency-10) | 3 |
| 12. | Nursing Process/Care Pathway applied to APN (Competency-9) | 2 |
| | SELF-LEARNING ASSIGNMENTS | |
| 1. | Identify Health Care and Education Policies and analyse its | 6 |
| | impact on Nursing | |
+----------+-------------------------------------------------------------+-------+
+----------+-------------------------------------------------------------+-------+
| S.No. | Topic | Hours |
+==========+=============================================================+=======+
| 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 primary and acute care geriatric units | |
+----------+-------------------------------------------------------------+-------+
| 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.
• De Nisco & Barkers A.M. (2015). Advanced Practice Nursing: Essential Knowledge for the Profession (3rd ed.),
Massachusetts: Jones & Bartlett Publishers Inc.
• 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 Geriatric Care
COMPETENCIES
1. Applies sound research knowledge and skills in conducting independent research in geriatric care setting.
2. Participates in collaborative research to improve in quality of patient care.
3. Interprets and uses research findings to produce EBP.
4. Tests/evaluates current practice to develop best practices and health outcomes and quality care.
5. Analyses the evidence for nursing interventions carried out in geriatric nursing practice to promote safety and
effectiveness of care.
6. Develops skill in writing scientific research reports.
Hours of Instruction: Theory: 56 + Lab/Skill Lab: 24 = 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 practice, participation in | |
| | collaborative research) | |
| | Introduction to Evidence Based Practice (EBP) project - | |
| | PICOT question, steps of planning, implementation, | |
| | evaluation and dissemination (project proposal and project | |
| | report) | |
| | Research Methodology | |
| | Phases/steps | |
| | (Research question, Review of literature, conceptual | |
| | framework, research designs, sampling, data collection, | |
| | methods & tools, Analysis and Reporting) | |
| | Writing research proposal and research report | |
| | (Competency-1, 2) | |
| 4. | Writing for publication | 5 |
| | (Writing workshop - Manuscript preparation and finding | |
| | funding sources) (Competency-6) | |
| 5. | Evidence based practice | 4 |
| | Concepts, principles, importance, and steps | |
| | Integrating EBP to work environment | |
| | Barriers to implement EBP | |
| | Strategies to promote EBP | |
| | (Competency-3, 4, 5) | |
+----------+-------------------------------------------------------------+-------+
| Total | | 56 |
| | | hours |
+----------+-------------------------------------------------------------+-------+
Practical/Lab & Assignments: 24 hours
• Identifying research priorities
• Writing exercises on research question, objectives, and hypothesis
• Writing research proposal/EBP project proposal
• Scientific paper writing - preparation of manuscript for publication
• Writing systematic reviews/literature review - Analyse the evidence for a given nursing intervention in geriatric
nursing.
Practicum
• Research practicum: Dissertation (336 hours = 7 weeks)/Evidence Based Practice Project (EBP project)
Bibliography
• Gray J. & Grove S.K. (2020). Burns & Groves. The Practice of Nursing Research: Appraisal, Synthesis and
Generation of Evidence (9th ed.), St. Louis: Elsevier Saunders.
• 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 geriatric care units.
2. Manages stress and conflicts effectively in a geriatric 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 geriatric patient care.
5. Builds teams and motivates others in a geriatric care setting.
6. Develops unit budget, manages supplies and staffing effectively.
7. Participates appropriately in times of innovation and change.
8. Uses effective teaching methods, media and evaluation based on sound principles of teaching.
9. Develops advocacy role in patient care, maintains quality and ethics in geriatric units in hospital and community
settings.
10. Provides counselling to families and patients in crisis situations particularly end of life care.
Hours of Instruction = Theory: 56 + Lab/Skill Lab: 24 = 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 geriatric| 4 |
| | care settings | |
| 4. | Stress management and conflict management - principles and | 4 |
| | application to geriatric care environment, effective time | |
| | management | |
| 5. | Quality improvement and audit | 4 |
| 6. | Problem solving, critical thinking and decision making, | 5 |
| | communication skills applied to geriatric care nursing | |
| | practice | |
| 7. | Team building, motivating and mentoring within geriatric | 2 |
| | ward and community set up | |
| 8. | Budgeting and management of resources including human | 5 |
| | resources in geriatric ward/community setting including | |
| | material management, staffing, and assignments | |
| 9. | Change and innovation | 2 |
| 10. | Staff performance and evaluation (performance appraisals) | 6 |
| 11. | Teaching-learning theories and principles applied to | 2 |
| | Geriatric Nursing | |
| 12. | Competency-based education and outcome-based education | 2 |
| 13. | Teaching methods/strategies - experiential, reflective, | 8 |
| | scenario based, simulation etc., media: educating patients | |
| | and staff in gerontology care settings | |
| 14. | Staff education and use of tools in evaluation | 4 |
+----------+-------------------------------------------------------------+-------+
+----------+-------------------------------------------------------------+-------+
| S.No. | Topic | Hours |
+==========+=============================================================+=======+
| 15. | APN - roles as a teacher | 2 |
| 16. | Advocacy roles in geriatric care environment | 2 |
+----------+-------------------------------------------------------------+-------+
| Total | | 56 |
| | | hours |
+----------+-------------------------------------------------------------+-------+
Practical/Lab = 24 hours
1. Preparation of staff patient assignment
2. Preparation of unit budget
3. Preparation of staff duty roster
4. Patient care audit
5. Preparation of nursing care standards and protocols
6. Management of equipment and supplies
7. Monitoring, evaluation, and writing report of infection control practices
8. Development of teaching plan
9. Micro teaching/patient education sessions
10. Preparation of teaching method and media for patients and staff
11. Planning and conducting OSCE/OSPE
12. Construction of tests
Assignment: Prepare Nursing care standards for a geriatric unit.
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 NURSING COURSES
IV. Advanced Pathophysiology applied to Geriatric Nursing
COMPETENCIES
1. Integrates the knowledge of pathophysiological process in geriatric conditions to diagnosis and formulating plan
of care.
2. Applies the pathophysiological principles in symptom management and secondary prevention of illnesses among
older adults.
3. Analyses the pathophysiological changes relevant to each geriatric illnesses recognizing the value of diagnosis,
treatment, care and prognosis
Hours of Instruction: Theory: 60 hours
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| I | 4 | IMMUNOLOGICAL FACTORS IN DISEASE |
| | | • Components of immune system |
| | | • Mechanism of the immune response |
| | | • Immune deficiency and lymph proliferative disorders |
| | | • Immunity |
| | | • Types of immune reactions |
| | | • Vaccines |
| II | 2 | INFECTION AND DISEASES |
| | | • Epidemiology and spread of infections |
| | | • Diagnosis and management of infections (RTI, UTI, Skin) |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| III | 4 | FLUID AND ELECTROLYTE BALANCE |
| | | • Hypernatremia and hyponatremia |
| | | • Hyperkalaemia and hypokalaemia |
| | | • Calcium - phosphate and magnesium metabolism/Vitamin D |
| | | • Disturbance in acid base |
| IV | 6 | CARDIOVASCULAR FUNCTION |
| | | Advanced pathophysiological process of cardiovascular |
| | | conditions |
| | | • Cardiomyopathies |
| | | • Myocarditis |
| | | • Hypertension |
| | | • Diseases of the aorta |
| | | • Peripheral vascular disease |
| | | • Ischemic heart disease |
| V | 4 | PULMONARY FUNCTION |
| | | Advanced pathophysiological process of pulmonary conditions |
| | | • Disease of the upper and lower respiratory tract |
| | | • Bronchial asthma, COPD, Cor pulmonale |
| | | • Acute and chronic respiratory failure |
| | | • Neoplasms of lung |
| | | • Interstitial lung disease (ILD) - Disease of pleura, |
| | | mediastinum and diaphragm |
| VI | 4 | GASTROINTESTINAL FUNCTION |
| | | Advanced pathophysiological process of gastrointestinal |
| | | conditions |
| | | • Diseases of the oesophagus |
| | | • Gastroesophageal reflux disease |
| | | • Peptic ulcer, gastritis |
| | | • Malignancy of stomach, colon |
| VII | 6 | HEPATOBILIARY AND PANCREATIC FUNCTION |
| | | Advanced pathophysiological process of hepatobiliary |
| | | conditions |
| | | • Diagnostic procedures in liver disorders |
| | | • Derangement of hepatic/biliary metabolism |
| | | • Acute hepatitis |
| | | • Chronic hepatitis |
| | | • Cirrhosis of liver |
| | | • Tumours of liver |
| | | • Liver abscess |
| | | • Cholecystitis, cholelithiasis |
| | | • Pancreatitis |
| | | • Pancreatic malignancy |
| VIII | 4 | ENDOCRINE FUNCTIONS |
| | | Advanced pathophysiological process of endocrine conditions|
| | | • Pituitary gland |
| | | • Diseases of the anterior pituitary |
| | | • Disorders of the neurohypophysis |
| | | • Hyper and hypothyroidism |
| | | • Hyper and hypoparathyroidism |
| | | • Diabetes mellitus |
| | | • Diseases of the adrenal cortex and medulla |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| IX | 6 | RENAL AND URINARY FUNCTIONS |
| | | Advanced pathophysiological process of the kidney and |
| | | urinary conditions |
| | | • Acute renal failure |
| | | • Chronic kidney disease |
| | | • Nephrotic syndrome |
| | | • Nephritic syndrome |
| | | • Vascular diseases of the kidney (Renal artery stenosis) |
| | | • Nephrolithiasis |
| | | • Obstructive uropathy |
| | | • Urinary tract infections |
| | | • Urinary incontinence |
| | | • Epididymo-orchitis |
| X | 6 | HAEMATOLOGICAL FUNCTION |
| | | Advanced pathophysiological process of haematological |
| | | conditions |
| | | • Blood formation and destruction |
| | | • Blood groups and blood transfusion reaction |
| | | • Anaemia |
| | | • Bone marrow failure |
| | | • Myeloproliferative disorders |
| | | • Idiopathic thrombocytopenic purpura (ITP) |
| | | • Leukaemia |
| | | • Lymphomas |
| XI | 4 | FUNCTIONS OF CONNECTIVE TISSUE, JOINTS, AND BONES |
| | | Advanced pathophysiological process of conditions affecting |
| | | connective tissue, joints and bones |
| | | • Rheumatoid arthritis |
| | | • Ankylosing spondylitis |
| | | • Systemic lupus erythematosus |
| | | • Polymyalgia |
| | | • Gout |
| | | • Osteoarthritis |
| | | • Diseases of bone - metabolic and endocrine |
| XII | 6 | NEUROLOGICAL FUNCTION |
| | | Advanced pathophysiological process of neurological |
| | | conditions |
| | | • Diagnostic tests in neurology - EMG, scans |
| | | • Coma |
| | | • Headache |
| | | • Epilepsy |
| | | • Sleep disorders - obstructive sleep apnoea |
| | | • Diseases of the cranial nerves |
| | | • Cerebrovascular diseases – CVA, Transient ischemic attack |
| | | • Spinal cord injury |
| | | • Peripheral neuropathy |
| | | • Pyogenic infections of the CNS - encephalitis, meningitis |
| | | • Viral infections - herpes zoster |
| | | • Demyelinating diseases |
| | | • Degenerative diseases - Parkinson's disease, progressive |
| | | supra nuclear palsy |
| | | • Metabolic and nutritional diseases in CNS - Vitamin B12, |
| | | Thiamine |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| XIII | 4 | INTEGUMENTARY FUNCTION |
| | | Advanced pathophysiological process of integumentary |
| | | conditions |
| | | • Cutaneous manifestation of systemic illness |
| | | • Generalised pruritis |
| | | • Skin pigmentation and Ichthyosis |
| | | • Scabies |
| | | • Photosensitivity |
| | | • Psoriasis |
| | | • Fungal infections of skin |
+------+-------+-------------------------------------------------------------+
Bibliography
• Berkowitz A. (2021). Clinical Pathophysiology (2nd ed.). MedMaster. Inc.
• Huether S.E., McCance K.L. & Brashers V.L. (2019). Understanding Pathophysiology (7th ed.). St. Louis,
Missouri: Elsevier.
• Norris T.L. (2020). Porth's Essentials of Pathophysiology. (5th ed.). Walters & Kluwer.
• Porth C.M. (2007). Essentials of Pathophysiology: Concepts of altered health states (4th ed.). Philadelphia:
Lippincott Williams and 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 Geriatric Nursing
COMPETENCIES
1. Applies the pharmacological principles in providing care to geriatric patients and families.
2. Analyses relevant pharmacotherapeutic drugs used in geriatric patients.
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 geriatric patients in the acute care
settings.
6. Guides their families in self-care management.
Hours of Instruction: Theory: 54 hours
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| I | 2 | INTRODUCTION TO PHARMACOLOGY IN GERIATRIC CARE |
| | | • History |
| | | • Index card |
| | | • Classification of drugs and schedules |
| II | 4 | PHARMACOKINETICS AND PHARMACO-DYNAMICS |
| | | • Introduction |
| | | • Absorption, Distribution, Metabolism, Distribution and |
| | | Excretion in older adult |
| | | • Plasma concentration, half life |
| | | • Loading and maintenance dose |
| | | • Therapeutic index and drug safety |
| | | • Potency and efficacy |
| | | • Principles of drug administration |
| | | • The rights of drug administration |
| | | • Systems of measurement |
| | | • Drug administration - enteral, topical, and parenteral |
| III | 5 | PHARMACOLOGY AND CARDIOVASCULAR ALTERATIONS IN OLDER |
| | | ADULT |
| | | • Medications in the management of angina pectoris, |
| | | myocardial infarction and heart failure |
| | | • Medications in the management of dysrhythmias, heart |
| | | block and conduction disturbances |
| | | • Medications in the management of atherosclerotic disease |
| | | of aorta and peripheral artery disease |
| | | • Medications in the management of deep vein thrombosis |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| IV | 4 | PHARMACOLOGY AND PULMONARY ALTERATIONS IN OLDER ADULTS |
| | | • Institutional Protocols/Standing Orders for cardiac |
| | | emergencies |
| | | • Medications in the management of status asthmaticus |
| | | • 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 |
| | | • Medications in the management of atelectasis |
| | | • Standing Orders for pulmonary emergencies |
| V | 6 | PHARMACOLOGY AND NEUROLOGICAL ALTERATIONS IN OLDER ADULTS |
| | | • Pain |
| | | WHO analgesic (pain) ladder |
| | | NSAID |
| | | Opioid analgesia |
| | | • Sedation |
| | | Gamma amino butyric acid stimulants |
| | | Dexmedetomidine |
| | | Analogizations |
| | | Sedation monitoring policy |
| | | • Delirium |
| | | Haloperidol |
| | | Atypical antipsychotics |
| | | • Medications used for local and general anaesthesia |
| | | Local - Amides, esters, and miscellaneous agents |
| | | General - Gases, Volatile liquids, IV anaesthetics |
| | | Non-anaesthetic drugs adjuncts to surgery |
| | | Patient controlled anaesthesia |
| | | • Paralytic Medications |
| | | Non-depolarizing and depolarizing agents |
| | | Anxiolytics |
| | | • Autonomic drugs |
| | | Adrenergic agents/sympathomimetics |
| | | Adrenergic blocking agents |
| | | Anti cholinergic agents |
| | | • Medications in the management of anxiety and insomnia |
| | | Antidepressants |
| | | Benzodiazepines |
| | | • Medications in the management of neurological conditions |
| | | Cerebro-vascular disease and cerebro-vascular accident |
| | | Encephalopathy |
| | | Acute head and spinal cord injury with elevated |
| | | intracranial pressure |
| | | Coma, unconsciousness, and persistent vegetative state |
| | | Seizure disorder |
| | | Parkinsonism |
| | | Alzheimer's disease |
| | | Bed bound patients |
| | | • Standing orders for neurological emergencies |
| VI | 5 | PHARMACOLOGY AND NEPHROLOGY ALTERATIONS IN OLDER ADULTS |
| | | • Diuretics |
| | | • Fluid replacement |
| | | Crystalloids |
| | | Colloids |
| | | • Electrolytes |
| | | • Sodium |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| | | Potassium |
| | | Calcium |
| | | Magnesium |
| | | Phosphorus |
| | | Bicarbonate |
| | | • Renal conditions |
| | | Medications in the management of acute/chronic renal |
| | | failure |
| | | Medications in the management of acute tubular necrosis |
| | | Medications used during dialysis. |
| | | • Standing orders for nephrology emergencies |
| VII | 5 | PHARMACOLOGY AND GASTROINTESTINAL ALTERATIONS IN OLDER |
| | | ADULTS |
| | | • Anti-ulcer drugs |
| | | • Laxatives |
| | | • Anti-diarrheal |
| | | • Anti-emetics |
| | | • Pancreatic enzymes |
| | | • Nutritional supplements, vitamins, and minerals |
| | | • Gastrointestinal conditions |
| | | • Medications in the management of |
| | | Gastrointestinal surgeries and liver transplant |
| | | Acute gastrointestinal bleeding |
| | | Hepatic failure |
| | | Acute pancreatitis |
| | | Hepatic encephalopathy |
| | | • Standing orders for gastrointestinal emergencies |
| VIII | 4 | PHARMACOLOGY AND ENDOCRINE ALTERATIONS IN OLDER ADULTS |
| | | • Hormonal therapy |
| | | • Insulin and other hypoglycaemic agents |
| | | • Endocrine critical care conditions |
| | | Medications in the management of hypoglycaemia and |
| | | hyperglycaemia |
| | | Medications in the management of hypothyroidism and |
| | | hyperthyroidism |
| | | Medications in the management of adrenal crisis |
| | | Medications in the management of SIADH |
| | | • Standing orders for endocrine emergencies |
| IX | 5 | PHARMACOLOGY AND HAEMATOLOGY ALTERATIONS IN OLDER ADULTS |
| | | • Anticoagulants |
| | | • Antiplatelet drugs |
| | | • Thrombolytics |
| | | • Haemostatics/antifibrinolytics |
| | | • Blood and blood products indication and reaction |
| | | Whole blood packed red blood cells, Leukocyte-reduced |
| | | red cells, Washed red blood cells, Fresh frozen plasma, |
| | | Cryoprecipitate |
| | | Transfusion reactions, transfusion administration process |
| | | Albumin |
| | | • Vaccines |
| | | • Immunosuppressant |
| | | • Chemotherapeutic drugs - alkylating agents, |
| | | anti-metabolites, anti-tumour antibiotics, alkaloids, |
| | | hormones and hormone antagonist, corticosteroids, |
| | | gonadal hormones, anti-oestrogens, androgen antagonists, |
| | | biologic response modifiers |
| | | • Haematology conditions |
| | | Medications in the management of anemia thrombocytopenia |
| | | Medications in the management of DIC |
| | | Medications in the management of thrombocytopenia and |
| | | acute leukemia |
| | | Medications in the management of tumor lysis syndrome |
| | | • Standing orders for hematology emergencies like graft |
| | | versus host disease |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| X | 2 | PHARMACOLOGY AND SKIN ALTERATIONS IN OLDER ADULT |
| | | • Medications used in burn management |
| | | • Medications used in wound management |
| | | • Standing orders for skin critical care emergencies |
| XI | 4 | PHARMACOLOGY AND MULTISYSTEM ALTERATIONS IN OLDER ADULT |
| | | • Medications in the management of shock, sepsis, multiple |
| | | organ dysfunction, systemic inflammatory response |
| | | syndrome, anaphylaxis |
| | | • Medications in the management of bites, drug overdose and |
| | | poisoning |
| | | • Medications in the management of short duration fever |
| | | Antipyretics |
| | | Corticosteroids |
| | | • Standing orders for multi system emergencies |
| XII | 6 | PHARMACOLOGY AND INFECTIONS IN OLDER ADULTS |
| | | • Antibacterial drugs |
| | | Introduction |
| | | Beta lactams - Penicillins, cephalosporins, monobactams, |
| | | carbapenems |
| | | Aminoglycosides |
| | | Anti MRSA drugs - Vancomycin |
| | | Macrolides |
| | | Quinolones |
| | | Miscellaneous - lincosamide group, nitroimidazole, |
| | | tetracycline and chloramphenicol, polymyxins, |
| | | anti-malarial, anti-fungal, anti-viral, anti-protozoal |
| | | drugs |
| | | • Choice of antimicrobials |
| | | • Infectious conditions |
| | | Medications in the management of HIV, Tetanus, SARS, |
| | | Rickettsiosis, Leptospirosis, Dengue, Malaria, |
| | | Chikungunya, Rabies, Avian flu and Swine flu, COVID |
| | | Barrier Nursing |
| | | • Standing orders for infectious emergencies |
| XIII | 2 | MISCELLANEOUS |
| | | • Polypharmacy |
| | | • Adherence to drugs |
| | | • Patient education and drug compliance |
| | | • General prescribing principles |
| | | • Drugs in Psychogeriatrics |
| | | Dementia |
| | | Delirium |
| | | Bipolar associative disorder |
| | | Depression |
| | | Insomnia |
+------+-------+-------------------------------------------------------------+
Bibliography
• Eisen H.J. (2020). Pharmacology of Immunosuppression (1st ed.). Springer.
• McKay G.A. & Walters M.R. (2021). Clinical Pharmacology and Therapeutics (10th ed.). Wiley-Blackwell.
• Tripathi K.D. (2019). Essentials of Medical Pharmacology (8th ed.). Jaypee Brothers Medical Publishers, New
Delhi.
• Wynne A.L., Woo T.M. & Olyaei A.J. (2007). Pharmacotherapeutics for Nurse Practitioner Prescribers (2nd ed.).
Philadelphia: Davis.
VI. Advanced Health/Physical Assessment
COMPETENCIES
1. Applies the physical assessment principles in developing appropriate system wise examination skills and specific
to falls, drugs, bed sore etc.
2. Uses advanced health assessment skills to differentiate between variations of normal and abnormal findings.
3. Orders screening and diagnostic tests based on the examination findings and institutional protocols.
4. Analyses the physical examination findings and results of various investigations and works collaboratively with
geriatricians needed for development of diagnoses.
5. Documents assessment, diagnosis, and management and monitors follow up care in partnership with health care
team members, patients, and families.
Hours of Instruction: Theory: 70 hours + Lab/Skill Lab: 48 hours
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| I | 4 | INTRODUCTION |
| | | • History taking |
| | | • Physical examination |
| | | System-wise assessment |
| II | 6 | CARDIOVASCULAR SYSTEM |
| | | • Cardiac history |
| | | • Physical examination |
| | | • Cardiac laboratory studies - biochemical markers, blood |
| | | investigations |
| | | • Cardiac diagnostic studies - electrocardiogram, |
| | | echocardiography, stress testing, radiological imaging |
| III | 6 | RESPIRATORY SYSTEM |
| | | • History |
| | | • Physical examination |
| | | • Respiratory monitoring - Arterial blood gases, pulse |
| | | oximetry |
| | | • Respiratory diagnostic tests - Chest radiography |
| | | (ventilation perfusion scanning, pulmonary angiography, |
| | | bronchoscopy, thoracentesis, sputum culture, pulmonary |
| | | function test) |
| IV | 8 | NERVOUS SYSTEM |
| | | • Neurological history |
| | | • General physical examination |
| | | • Assessment of cognitive function |
| | | • Assessment of higher mental function |
| | | • Motor assessment - muscle strength, power, and reflexes |
| | | • Cerebellar function - gait |
| | | • Sensory assessment - dermatome assessment |
| | | • Neurodiagnostic studies - CT scan, MRI, PET, eye/hearing |
| V | 6 | RENAL SYSTEM |
| | | • History |
| | | • Physical examination |
| | | • Assessment of renal function |
| | | • Assessment of fluid balance |
| VI | 4 | GASTROINTESTINAL SYSTEM |
| | | • History |
| | | • Physical examination |
| | | • Nutritional assessment |
| | | • Laboratory studies - liver function studies, blood |
| | | parameters, stool tests |
| | | • Diagnostic studies - radiological studies, imaging |
| | | studies and endoscopic studies |
| VII | 4 | ENDOCRINE SYSTEM |
| | | • History, physical examination, laboratory studies and |
| | | diagnostic studies of |
| | | Pituitary gland |
| | | Thyroid gland |
| | | Parathyroid gland |
| | | Endocrine gland - diabetes mellitus |
| | | Adrenal gland |
| VIII | 4 | HAEMATOLOGICAL SYSTEM |
| | | • History |
| | | • Physical examination |
| | | • Laboratory studies - blood investigations |
| | | • Diagnostic studies - bone marrow aspiration |
| IX | 3 | INTEGUMENTARY SYSTEM |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| | | • History |
| | | • Physical examination |
| | | • Pathological examination - tissue examination |
| X | 6 | MUSCULOSKELETAL SYSTEM |
| | | • History |
| | | • Physical examination - gait and joint assessment |
| | | • Laboratory studies - blood parameters (inflammatory |
| | | markers, uric acid) |
| | | • Diagnostic studies - radiological studies |
| XI | 5 | REPRODUCTIVE SYSTEM (MALE & FEMALE) |
| | | • History |
| | | • Physical examination |
| | | • Laboratory studies |
| | | • Diagnostic studies |
| | | • Post menopausal problems - hot flush |
| XII | 4 | SENSORY ORGANS |
| | | • History |
| | | • Physical examination |
| | | • Laboratory studies |
| | | • Diagnostic studies - radiological and imaging studies, |
| | | endoscopic studies |
| XIII | 10 | COMPREHENSIVE GERIATRIC HEALTH ASSESSMENT |
| | | • History |
| | | • Physical examination |
| | | • Functional assessment |
| | | • Safety assessment |
| | | • ADL assessment |
| | | • Fragility assessment |
| | | • Nutritional assessment |
| | | • Psychosocial assessment |
+------+-------+-------------------------------------------------------------+
List of skills to be practiced in the skill lab (48 hours include demonstration by the faculty and practice by the
students)
• Comprehensive geriatric assessment
• Monitoring clinical parameters (system wise) & investigations
• Invasive BP monitoring, Multi-parameter Monitors, ECG, ABG, Pulse Oximetry, Glasgow Coma Scale (GCS),
Pain and Sedation score Motor assessment, Sensory assessment, Renal function tests, Fluid balance, acid base
balance, electrolytes, Bowel sounds, Abdominal pressure, Residual gastric volume, Liver function tests, GRBS,
Lab tests, Radiological and Imaging tests (system wise)
• Ordering and interpretation of screening and diagnostic tests (system wise) (See enclosed Appendix-3)
• Assessment of Older adults (See enclosed Assessment Guidelines)
Bibliography
• Bickley L.S. & Szilagyi P.G. (2018). Bates' guide to physical examination and history taking (South Asian Ed.).
Wolters Kluwer India Pvt. Ltd.
• Rhoads J. (2013). Advanced health assessment and diagnostic reasoning (2nd Ed.). Philadelphia: Lippincott
Williams & Wilkins.
• Wilson S.F. & Giddens J.F. (2021). Health assessment for nursing practice (7th Ed.). Elsevier - Health Sciences
Division.
IInd YEAR
GERIATRIC SPECIALTY COURSES
(Foundations of Geriatric Nursing Practice, Geriatric Nursing - I and Geriatric Nursing - II)
COMPETENCIES
1. Demonstrates knowledge about developmental, age related, and gender specific variations.
2. Obtains relevant comprehensive and problem-focused health histories for complex, acute, critical, and chronically
ill patients.
3. Evaluates signs and symptoms, including age-appropriate changes.
4. Prioritizes data collection, according to the patient's age, immediate condition or needs, as a continuous process.
5. Accurately documents relevant comprehensive and problem-focused health histories.
6. Performs and accurately documents a pertinent, comprehensive, and focused physical, mental health and
cognitive assessment.
7. Assesses the impact of family, community, and environment, including economic, work, institutional, school,
social, and living environments, on an individual's health status and quality of life.
8. Assesses the individual's and support system's ability to cope with and manage developmental (life stage)
transitions.
9. Determines the individual's ability to participate in care, care decisions, work, school, physical, and social
activities.
VII. Foundations of Geriatric Nursing Practice
Hours of Instruction: Theory: 96 hours + Lab/Skill Lab: 48 hours
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| I | 6 | INTRODUCTION & HEALTHY AGEING |
| | | • Biology of ageing |
| | | • Epidemiology of human ageing |
| | | • Immunology of human ageing |
| II | 6 | OVERVIEW OF GERIATRIC NURSING |
| | | • Foundations of the specialty of geriatric nursing |
| | | • Demographic profile of the older population |
| | | • Health status of older adults |
| | | • Burden of geriatric care - global and national |
| | | • Impact of an ageing adult population on geriatric nursing |
| | | • Health risks in older person |
| III | 10 | GERIATRIC NURSING: CONCEPTS AND PRINICPLES |
| | | • Definition, concepts, and principles of geriatric nursing |
| | | • Ageing process |
| | | • Women's ageing |
| | | • Nursing process |
| | | • Levels of geriatric care and role of nurse |
| | | • Geriatric care team: geriatric physician, geriatric nurse,|
| | | neuro psychiatrist, occupational therapist, |
| | | physiotherapist, ALC department staff, psycho-geriatrician,|
| | | speech therapist, social worker, religious leader |
| | | • Role of specialists in geriatric care and geriatric nurse |
| | | practitioner |
| | | • Principles of prevention of infections in older person |
| | | • Standard safety measures and biomedical waste management |
| IV | 8 | ADVANCED GERIATRIC NURSING ASSESSMENT |
| | | • Comprehensive and focused health history and physical |
| | | assessment |
| | | • Evaluation of newly worsened health status |
| | | • Components - clinical, functional, activities of daily |
| | | living (ADL), environment, social support, mental status |
| | | examination (MSE) |
| | | • Multidisciplinary geriatric assessment |
| | | • Tools and scales for assessment - cognitive scales |
| V | 12 | PSYCHOSOCIAL ISSUES RELEVANT TO GERIATRIC NURSING |
| | | • Psychosocial aspects of ageing |
| | | • Psychological changes in ageing |
| | | • Learning, motivation, attention, and perception |
| | | • Emotions |
| | | • Human behaviour and needs in crisis |
| | | • Stress and coping in crisis situations |
| | | • Attitudes and caring with humanity |
| | | • Social organization and community resources |
| | | • Leadership role in community |
| | | • Social roles and aspects in care of older persons |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| VI | 10 | INFLUENCES ON HEALTH AND ILLNESS |
| | | A. Cultural |
| | | • Demographics |
| | | • Cultural concepts |
| | | • Cultural variation in health and illness |
| | | • Concepts of intercultural communication with older adults |
| | | • Cultural theory and framework |
| | | B. Family |
| | | • Role and functions of families |
| | | • Common late life family issues and decisions |
| | | • Family care giving |
| | | • Caregiver burden |
| | | • Working with ageing families - strategies |
| | | C. Socioeconomic and Environment |
| | | • Socioeconomic factors |
| | | • Environmental influences |
| | | • Advocacy |
| VII | 8 | SOCIAL SUPPORT AND SERVICES FOR AGEING |
| | | • National policies and national health policies for older |
| | | persons |
| | | • Ageing and its influence in society |
| | | • Role of governmental organizations and NGOs |
| | | • Agencies working for the older person: national and state |
| | | • Social support and social networking, self-help groups, |
| | | older person clubs, role of police |
| | | • Welfare measures and provision for the older persons - |
| | | schemes available - national and state |
| VIII | 12 | SPECIAL NEEDS IN GERIATRICS |
| | | A. Nutrition |
| | | • Assessment |
| | | • Nutritional advice |
| | | • Wellness: health promotion |
| | | • Nutrition, Exercise |
| | | B. Sleep and Activity |
| | | • Stages of sleep |
| | | • Normal age-related changes in sleep |
| | | • Drugs influencing sleep |
| | | • Sleep disorders and conditions influencing sleep |
| | | • Management of sleep disorders |
| | | C. Intimacy and Sexuality |
| | | • Normal changes of ageing sexual response |
| | | • Alternative sexual practices |
| | | • Pathologic conditions affecting older adults' sexual |
| | | response |
| | | • Environmental barriers to sexual practice |
| | | D. Safety |
| | | • Risk factors in rehabilitation setting |
| | | • Prevention |
| | | • Major non-fall related injuries |
| | | • Vulnerable patients |
| | | E. Mental Health |
| | | • Major mental health problems - Bipolar affective |
| | | disorder, depression |
| | | • Mental health resources |
| IX | 12 | COMMON PSYCHOPHYSIOLOGIC STRESSORS |
| | | A. Chronic Illness and Rehabilitation |
| | | • Chronicity |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| | | • Rehabilitation |
| | | B. Cancer |
| | | • Overview of cancer |
| | | • Psychosocial impact of cancer |
| | | • Spirituality and cancer |
| | | C. Pain |
| | | • Overview of pain in the older adult |
| | | D. Infection |
| | | • Age related changes in the immune system |
| | | • Factors affecting immunocompetence |
| | | • Common problems and conditions |
| | | E. Substance Abuse |
| | | • Risk factors |
| | | • Assessment |
| | | • Interventions |
| | | • Commonly abused substances in the older adult |
| | | • Future trends |
| | | F. Loss, Dying and Death |
| | | • Loss, grief and mourning |
| | | • The process of dying: older person's perspective |
| X | 12 | LEGAL AND ETHICAL ISSUES |
| | | • Ethical principles, ethical decision making - advance |
| | | directive, Will |
| | | • Euthanasia |
| | | • Ethical issues in geriatric medicine |
| | | • Strategies in promoting ethical decision making |
| | | • Organ donation, brain death - nurses' role |
| | | • Government Acts |
| | | • Help Age India |
| | | • Senior Citizen Act |
| | | • Social justice |
| | | • Social agencies - role of NGO |
| | | • End of life care |
+------+-------+-------------------------------------------------------------+
List of skills to be practiced in the skill lab (48 hours include demonstration by the faculty and practice by the
students)
• Assessment and health teaching on immunization
• Mini mental status examination
• Biomedical waste management
• Geriatric home visit for societal support
• Investigations: Cancer screening
VIII. Geriatric Nursing - I
COMPETENCIES
1. Assesses the impact of an acute, critical, and/or chronic illness or injury and the health promotion needs, social
support and physical and mental health status.
2. Identifies the presence of co-morbidities, age-related changes, their impact on presenting health problems,
potential for rapid physiologic and mental health deterioration.
3. Plans diagnostic strategies and appropriate uses of diagnostic tools to screen for and prevent squeal of acute and
critical illnesses.
4. Manages the evaluation of acute, critical, and chronically ill patients through ordering, interpretation,
performance, and supervision of diagnostic testing and clinical procedures.
5. Performs specific diagnostic strategies and technical skills to monitor and sustain physiological function and
ensure patient safety.
6. Provides anticipatory guidance and counselling to individuals and their families based on identified health
promotion needs.
Hours of Instruction: Theory 96 hours + Lab/Skill Lab: 48 hours
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| I | 22 | NURSING CARE OF ELDERLY WITH SYSTEMWISE AGE RELATED |
| | | CHANGES AND COMMON DISORDERS |
| | | Cardiovascular function |
| | | • Common cardiovascular problems in elderly |
| | | Respiratory function |
| | | • Age related changes in structure and function |
| | | • Respiratory changes associated with anaesthesia and |
| | | surgery |
| | | • Common respiratory problems and conditions in older |
| | | person |
| | | • Bronchopulmonary infection |
| | | Endocrine function |
| | | • Incidence of general pathology to the endocrine system |
| | | in older adult |
| | | • Normal glucose metabolism |
| | | • Age related changes in glucose metabolism |
| | | • Age related changes in the thyroid |
| | | • Common problems in thyroid |
| | | Liver function |
| | | • Age related changes in structure and function of liver |
| | | • Common problems and conditions |
| | | Gastrointestinal function |
| | | • Age related changes in structure and function in |
| | | gastrointestinal system |
| | | • Common problems and conditions |
| | | Urinary function |
| | | • Age related changes in urinary tract |
| | | • Common problems and conditions |
| | | • Urinary incontinence in the elderly |
| | | • Normal prostate structure and function |
| | | • Common problems in prostate |
| | | • Sexual function |
| | | Neurological function |
| | | • Normal age-related changes of the neurologic system |
| | | Neurological problems |
| | | • Transient Ischemic Attack |
| | | • Cerebrovascular Disorders and Stroke |
| | | • Parkinson's disease |
| | | Integumentary system |
| | | • Age related changes in skin structure and function |
| | | • Common problems and conditions |
| | | • Infection |
| | | • Pressure sores |
| | | Sensory function |
| | | Vision |
| | | • Age related changes |
| | | • Common complaints in vision |
| | | Hearing and balance |
| | | • Auditory structures and their functions |
| | | • Age related changes |
| | | • Hearing loss |
| | | • Management of hearing disability |
| | | • Balance |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| | | • Taste and smell |
| | | • Age related changes in sensory function |
| | | • Touch |
| | | • Dental problems |
| | | Musculoskeletal function |
| | | • Age related changes in structure and function |
| | | • Management of musculoskeletal disorders |
| II | 6 | COGNITIVE DISORDERS |
| | | Altered thought process |
| | | • Delirium/acute confusion state |
| | | • Dementia |
| | | • Depression |
| III | 14 | MENTAL DISORDERS IN ELDERLY |
| | | • Epidemiology of mental disorders |
| | | • Definition and classification of psychiatric disorders |
| | | • Depression in old age |
| | | • Bipolar disorder |
| | | • Functional psychiatric disorders in old age |
| | | • Personality and behavioural disorders |
| | | • Psycho geriatric service |
| | | • Management of psychiatric illness |
| | | • Alcoholism and the elderly patient |
| | | • Care giver's problems |
| IV | 6 | HOME CARE SERVICES |
| | | • Geriatric home care services in India and western |
| | | countries |
| | | • Hospice care |
| | | • Care giver's role |
| | | • Ambulatory care |
| | | • Assistive devices |
| V | 6 | QUALITY ASSURANCE |
| | | • Quality assurance models applicable to geriatrics |
| | | • Standards, protocols, policies, procedures |
| | | Infection control and practices |
| | | • Standard safety measures |
| | | • Nursing audit |
| | | • Staffing |
| VI | 12 | SURGERY IN THE ELDERLY |
| | | • Preoperative assessment |
| | | • Priorities for surgery |
| | | • Surgical emergencies |
| | | • Fractures |
| | | • Pathological fractures |
| | | • Benign lesions |
| | | • Gangrene - amputation |
| | | • Elective surgery |
| | | • Post operative problems and management |
| | | • Anaesthesia in old age |
| VII | 10 | SPECIAL PROBLEMS |
| | | Geriatric Syndrome |
| | | • Pressure sore |
| | | • Care of the chronically ill |
| | | • Care of patients with terminal illness |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| | | • Religion and illness |
| | | • Falls |
| | | • Nursing home placement |
| | | • Syncope |
| | | • Frailty |
| | | • Palliative care |
| | | Gynaecological problems among elderly women |
| | | • Gynaecological crisis |
| | | • Vulvovaginal inflammation |
| | | • Genital prolapses |
| | | • Postmenopausal bleeding |
| | | • Alterations in bladder function |
| | | • Hormone treatment in postmenopausal women |
| VIII | 10 | PREVENTIVE GERIATRICS |
| | | • Preventing diseases and promoting health in old age |
| | | • Theories/models of health promotion |
| | | • Health belief model - general health practices in elderly |
| | | • Exercise in the elderly - physical and mental domain - |
| | | benefits of exercise |
| | | • Development of anticipatory care and its rationale |
| | | • Health promotion needs of older patients |
| | | • Health promotion and health education in the elderly |
| | | • Guidance and counselling to patients and families to meet |
| | | health promotion needs |
| | | • Anti-ageing interventions |
| | | • Prevention of adverse drug reaction |
| | | • Immunization |
| IX | 10 | REHABILITATION |
| | | • The concepts and history of rehabilitation |
| | | • Goals of rehabilitation |
| | | • Principles of rehabilitation |
| | | • Rehabilitation in old age |
| | | • Rehabilitation as teamwork |
| | | • Self-care evaluation and management of activities of |
| | | daily living |
| | | • Aids and application |
| | | • Role of physiotherapy in elderly |
| | | • Contractures and other deleterious effects of immobility |
| | | • Pressure ulcer |
| | | • Rehabilitation of stroke in the elderly |
| | | • Rehabilitation of specific diseases |
| | | • Organization and effectiveness of rehabilitation services |
| | | • Geriatric unit, day hospital, day care centre, long stay |
| | | care institution |
+------+-------+-------------------------------------------------------------+
List of skills to be practiced in the skill lab (48 hours include demonstration by the faculty and practice by the
students)
Diagnostic tool: geriatric depression scale, mini cog test, CAM ICU scale
Psychometric testing
Health education on assistive devices at home
Quality project - infection control practice
Preoperative preparation
Care of patient with traction, splint, cast and amputation
Wound dressing
Podiatric care
Investigations: HUT test
IX. Geriatric Nursing - II
COMPETENCIES
1. Individualizes the plan of care to reflect the dynamic nature of the patient's condition, age, developmental and life
transitions, patients, and family's needs.
2. Uses pharmacologic and non-pharmacologic management strategies to ameliorate physical and behavioural
symptoms in individuals who have psychiatric/substance misuse disorders.
3. Prescribes medications maintaining awareness of and monitoring for adverse drug outcomes and complex medical
regimens, especially in high-risk and vulnerable populations.
4. Manages pain and sedation for patients with complex acute, critical, and chronic illness.
5. Provides education and counselling to individuals and their families based on identified education and counselling
needs.
Hours of Instruction: Theory 96 hours + Lab/Skill Lab: 48 hours
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| I | 4 | INTRODUCTION |
| | | • Morbidity and mortality in old age |
| | | • Stereotyping of ageing - common myths and facts |
| | | • Nursing process in caring for older patients |
| | | • Challenges in caring for older adults |
| | | • Role of nurse in supporting older adults |
| II | 6 | MALIGNANCIES IN OLD AGE |
| | | • Cancer in old age |
| | | • Women and cancer: Breast cancer, endometrial and cervical |
| | | cancer |
| | | • Cancer screening in women |
| | | • Principles of management: surgery, radiotherapy, |
| | | chemotherapy |
| | | • Quality of life in older person with cancer |
| | | • Palliative care |
| | | • Hospice care |
| | | • Care of terminally ill - end of life care |
| III | 10 | ADVANCES IN GERIATRIC MEDICINE |
| | | • Alzheimer's disease |
| | | • Parkinsonism |
| | | • Osteoporosis |
| | | • Urinary incontinence |
| | | • Falls/prevention of fractures |
| | | • Parenteral nutrition |
| | | • Stroke clinic and memory clinic |
| | | • Anti-ageing research |
| IV | 20 | SPECIAL CARE SETTINGS |
| | | Acute Care |
| | | • Acute care environment |
| | | • Client care issues |
| | | • Future trends and research |
| | | • Counselling - end of life care |
| | | Home Care |
| | | • Quality of life |
| | | • Community based long term care |
| | | • Home care |
| | | • Profile of home health agencies |
| | | • Continuity of care |
| | | • Implementing the plan of treatment |
| | | • Home care management and support |
| | | • Quality assessment and improvement |
+------+-------+-------------------------------------------------------------+
+------+-------+-------------------------------------------------------------+
| Unit | Hours | Content |
+======+=======+=============================================================+
| V | 10 | Long Term Care |
| | | • Clinical aspects of the nursing facility |
| | | • Management aspects of the nursing facility |
| | | • Specialty care settings |
| | | • A resident's perspective of life in a nursing facility |
| | | • Family involvement in nursing facility |
| | | • Innovations |
| | | • Futuristic goals in nursing care |
| | | ELDER ABUSE AND VIOLENCE |
| | | • Identification of elder abuse |
| | | • Likely victims |
| | | • Prevention and management |
| | | • Counselling client, abuser/family |
| VI | 6 | CAREGIVER STRESS |
| | | • Burden of care giving |
| | | • Assessment of caregiver burden |
| | | • Supportive the care giver |
| VII | 10 | AGE FRIENDLY ENVIRONMENT |
| | | • Safety considerations, prevention of risks, fall injuries |
| | | • Modifications in home, institutions and community: |
| | | roads, buildings, hospitals, public places, old age homes |
| | | • Technology to enhance independence |
| | | • Assisting devices |
| | | • Role of society, neighbours, police |
| VIII | 6 | THERAPEUTIC RELATIONSHIP |
| | | • Nurse patient relationship |
| | | • Therapeutic communication skills |
| | | • Therapeutic touch |
| | | • Role of a nurse in caring an elderly |
| | | • Nursing care home |
| IX | 4 | PATIENT AND FAMILY EDUCATION AND COUNSELLING |
| | | • Challenges of patient and family education |
| | | • Process of adult learning |
| | | • Factors affecting teaching learning process |
| | | • Informational needs of families in geriatric care |
| | | • Counselling needs of patient and family |
| | | • Counselling techniques |
| X | 20 | COMMUNITY HEALTH: |
| | | HEALTH SERVICES AND PROGRAMS FOR OLDER ADULT |
| | | • Older women in rural India |
| | | • Types of services for care of older adult |
| | | • Health promotion and disease prevention |
| | | Health education |
| | | Screening of general health |
| | | Screening for cancer of uterine cervix |
| | | Specific health promotion programs (smoking cessation, |
| | | immunization) |
| | | • Curative |
| | | Early diagnosis and treatment of day-to-day ill health |
| | | in PHC, Medicare, mobile clinics |
| | | Health insurance/securities |
| | | Diagnosis and treatment of serious ill health in |
| | | secondary and tertiary care hospitals |
| | | Chronic care in home |
| | | • Rehabilitative |
+------+-------+-------------------------------------------------------------+
List of skills to be practiced in the skill lab (48 hours include demonstration by the faculty and practice by the
students)
• Pain assessment - WHO ladder, VAS
• Administration of chemotherapy drugs
• Post monitoring of radiation therapy
• Monitoring clinical parameters (system wise)
• Total parenteral nutrition (TPN)
• Investigations : bladder ultrasound, uroflowmetry
• Bladder diary
• Pelvic floor exercise
• BLS/ACLS
• PHC visit
• Counselling: End of life care
Bibliography
• Cash Jill and Glass Cherya (2019). Adult Gerontology Guidelines (2nd ed.), Springer Publication, New York.
• Carpenter Dawn (2019). Adult Gerontology acute care nurse practitioner Q & A review, Springer publication,
New York.
• Charolotte Eliopoulos (2022). Gerontological Nursing (10th ed.), Philadelphia: Wolters Kluwer Publications.
• Linton Adrianne D. & Lach H.W. (2007). Matteson and McConnell's Gerontological Nursing Concepts and
Practice (3rd ed.), Saunders Publication.
• Sharma K.L. (2007). Studies in gerontology intergenerational perspectives, Rawat Publications, Jaipur.
• Geriatric Tool Kit, Texas Nurses Association https://cdn.ymaws.com/www.texasnurses.org/resource/
resmgr/docs/practice/Geriatric_Competency - Full .pdf
• National Medical Council: https://www.nmc.org.in/information-desk/for-colleges/pg-curricula-2.,
https://www.nmc.org.in/wp-content/uploads/2019/09/MD-Geriatrics.pdf
• National Geriatric Council: https://main.mohfw.gov.in/sites/default/files/8324324521Operational
Guidelines_NPHCE_final.pdf
APPENDIX-1
LIST OF EQUIPMENT FOR A THIRTY BEDDED GERIATRIC WARD
1. Adjustable geriatric cot wit mattress (head end, foot end elevation, cot raising facility, trapeze bar, foot board,
side rails - 30
2. IV stand - 20
3. Bed side locker - 30
4. Over bed trolley - 30
5. Dressing trolley (Small) - 5
6. Dressing trolley (medium) - 2
7. Syringe pump - 10
8. Infusion pump - 10
9. Alpha mattress or air mattress - 25
10. Monitors - 10
11. Transport monitor/pulse oximeter - 2
12. ECG machine - 1
13. Ultrasound machine (bladder) - 1
14. Defibrillator - 1
15. Crash cart - 1
16. Crash cart items: Ambu bag, Laryngoscope, drugs, suction catheters
17. Height adjustable transfer trolley - 4
18. OR trolley - 1
19. Wheelchair with lock - 6
20. Safe slider - 1
21. Computer - 4
22. Printers - 2
23. Oxygen flowmeter - 15
24. Suction port with jar - 15
25. Pulmo-aid - 10
26. Refrigerator - 3 (1 - feeds, 1 - drugs, 1 - other use)
27. Metal footstep/foot stool - 20
28. Ambulation geriatric chair - 6
29. Flat trolley - 1
30. Spotlight - 2
31. Glucometer - 6
32. Tuning fork - 2
33. Ophthalmoscope - 1
34. Otoscope - 1
35. Knee hammer - 2
36. Inch tape - 2
37. Assistive devices - Walker, quadripods, tripod
38. Trays with sterile sets/disposable sets for various procedures (e.g., Insertion of central venous catheter,
tracheostomy etc.)
39. Snellen's chart
40. Nebulizer - 4
41. Pulse Oximeter - 2
Other items for mobility and exercise: minimum standard
42. Cervical traction (intermittent)
43. Walking for gait training equipment
44. Walking Sticks/Callipers
45. Shoulder Wheel
46. Pulley
47. Walker (ordinary)
48. Cervical traction (manual)
Physiotherapy equipment
Short wave diathermy, wax bath, Interferential Therapy Unit, Exercise Therapy Unit - Parallel Bars, Stationery
Cycle, Mariner's Wheel etc. Assistive Devices - Working frames, Wheelchairs, Bedside Chairs, Hoist, tilt table etc.
Setting up geriatric ward
• Oxygen outlets - 2
• Vacuum outlets - 2
• Compressed air outlets - 1
• Electric outlets (2 on each side of patients) with 5/15-amp pins
• Central nursing station
The Department of Geriatrics in the Medical College hospitals should have the following building outlay for the
inpatient and outpatient services.
OPERATIONAL GUIDELINES
Out Patient Department
a. Waiting hall/registration room - 36 sq.m. with computer, telephone.
b. Three OPD Cubicles - 6 sq.m. each
с. Pharmacy
d. Special Clinic
e. Resuscitation room
f. Physiotherapy (for both out-patients and in-patients)
g. ECG - 12 sq.m.
h. Basic Radiology Services
i. Laboratory/sample collection room
j. Counselling room
k. Demonstration room - 36 sq.m.
l. Library
m. Faculty room - 11 sq.m.
n. Injection/procedure room - 12 sq.m.
In-patient Services (30 bed ward)
• Male wards: 15 beds (3 acute care, 7 sub-acute care and 5 long term care)
• Female wards: 15 beds (3 acute care, 7 sub-acute care and 5 long term care)
• Pantry room, linen room, nursing station, duty doctor's room, side lab, procedure room, class room, lecture hall,
faculty room, library, administrative office, Storeroom, bathroom with shower chair facility, shower stretcher,
recreational hall.
General Guidelines of Age-Friend Environment
• Wide corridors, ramps, railings, grab bars, anti-skid tiles, adequate illumination, Allen door key lock/toilet for the
disabled and elevators should be implemented in the outpatient and inpatient facility.
• Items for occupational therapy services - art and craft items, indoor games items, charts, television.
• Develop a comprehensive database, website, practice guidelines, model outpatient and inpatients records,
assessment (cognitive and functionality).
• Carry out research on: the biology of ageing, social and psychological aspects of ageing and family support,
caregiver burden, epidemiology of various old age disease, innovations in interventions, anti-ageing medicine
etc., as single centre or multi-centric studies with funding from national and international agencies.
(Ref: MOHFW guidelines)
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 and Quiz: 10 marks
Written assignment/term paper: 10 marks (Global and National Healthcare Trends & Policies)
Clinical seminar (Clinical/Care pathway in specific clinical condition/Application of specific nursing theory): 5
marks
Final theory exam: 25 marks
Total: 50 marks
2. Research Application and Evidence Based Practice in Geriatric Care
Theory:
Test papers: 20 marks
Written assignment: 5 marks (Literature review/Preparation of research instrument)
Journal club: 5 marks (Analysis of research evidence for nursing competencies)
Total: 30 marks
3. Advanced Skills in Leadership, Management and Teaching
Theory:
Test papers: 15 marks
Journal club (Trends in Leadership/Management/Teaching): 5 marks
Written assignment: 5 marks (Geriatric syndrome)
Microteaching: 5 marks
Total: 30 marks
4. Advanced Pathophysiology & Advanced Pharmacology applied to Geriatric Nursing
Theory:
Test papers and Quiz: 20 marks (Pathophysiology - 10, Pharmacology - 10)
Drug studies: 5 marks (Drug study and presentation)
Case presentation and case study report (Pathophysiology): 5 marks
Total: 30 Marks
5. Advanced Health/Physical Assessment
Theory:
Test papers: 20 marks
Written assignment: 10 marks (Diagnostic/investigatory reports - interpretation and analysis of findings)
Total: 30 marks
Practicum:
Clinical performance evaluation: 10 marks
End of posting exam (OSCE): 10 marks
Case presentation and case study report: 5 marks
Internal OSCE: 25 marks
Total Internal practical: 50 marks
(End of posting exam can be conducted in any Geriatric Ward/unit, one practical session should be in the
community)
IInd Year
1. Foundations of Geriatric Nursing Practice
Theory:
Test papers and Quiz: 20 marks
Written assignment: 10 marks (Government programs)
Total: 30 marks
Practicum:
Clinical performance evaluation: 20 marks
Drug studies (Drug study and presentation): 10 marks
Case presentation and case study report (Family education/counselling): 5 marks
Case presentation (Application of Clinical/Care Pathway): 5 marks
End of posting exam (OSCE): 10 marks
Internal OSCE: 50 marks
Total Internal practical: 100 marks
2. Geriatric 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. Geriatric Nursing - II
Theory:
Test papers: 20 marks
Clinical Seminar: 10 marks
Total: 30 marks
Practicum:
Clinical performance evaluation: 20 marks
End of posting (OSCE): 10 marks
Clinical presentation: 10 marks
Case study report (Developed clinical/care pathway): 10 marks.
Internal OSCE: 50 marks
Total Internal practical: 100 marks
(End of posting exam can be conducted in any Geriatric Ward/unit, one practical session should be in the
community)
4. Dissertation
Practicum: 50 marks
EXTERNAL (FINAL) EXAMINATION (As per schedule in syllabus)
Theory: Short answer and essay type questions (Weightage can be decided by the University)
{Essay 2 x 15 marks = 30, Short answers 5 × 6 marks = 30, Very short answers 5 × 2 marks = 10}
OSCE GUIDELINES FOR INTERNAL AND EXTERNAL PRACTICAL EXAMINATION
Ist YEAR
I. HEALTH ASSESSMENT
INTERNAL
OSCE: 25 marks
CORE COMPETENCY DOMAINS
1. Focused history taking
2. Physical examination of a geriatric patient
3. Interpretation of findings and results
4. Monitoring of clinical parameters
5. Scales - cognitive, depression, bedsore etc.
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 geriatric patient
2. Focused physical examination of geriatric patient
3. Interpretation of history
4. Interpretation of physical exam findings
5. Interpretation of results of laboratory diagnostic tests
6. 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
II. FOUNDATIONS OF GERIATRIC NURSING PRACTICE, GERIATRIC NURSING - I & GERIATRIC
NURSING - II
(The same pattern described below is followed for all the three courses respectively)
INTERNAL
OSCE: 50 Marks
CORE COMPETENCY DOMAINS
1. Focused history taking and physical examination and interpretation of findings and results
2. Monitoring competencies (Geriatric assessment)
3. Therapeutic interventions (Emergency procedural competencies) including drug administration
4. Family education and counselling - breaking bad news, case education
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 geriatric patient
2. Monitoring competencies
3. Development of care plan
4. Family education and counselling
5. Therapeutic interventions (Emergency procedures) including drug administration
6. Family centred care
Number of stations: 10 (8 + 2 Rest stations)
Time for each station: 10 minutes
Marks for each station: 10 marks (As per competency Check list and allotted marks)
Total: 8 × 10 = 80 marks
Oral exam = 20 marks
Total = 100 marks
On completion of procedural competencies in log book and clinical requirements, the NP student
is qualified to appear for final practical examination.
Specific guidelines for using assessment scales
a. Skin integrity - Braden scale, Norton pressure sore risk assessment scale.
b. Urinary incontinence - IPSS questionnaire, male urogenital distress inventory (MUDI).
с. Geriatric syndrome - SPICES Tool (sleep disorders, problems with eating or feeding, incontinence, confusion,
evidence of falls, skin breakdown), comprehensive geriatric assessment.
d. Nutritional status assessment - 72 hours recall, swallowing assessment.
e. Pain - Pain scale assessment (visual analogue scale), geriatric pain assessment.
f. Sleep - Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS).
g. Cognitive function - Geriatric Depression Scale (GDS), the Impact of Event scale, CAM - ICU - Confusion
assessment method for ICU, Mini Cog test, TUG test, Folstein Mini Mental Status Examination (MMSE),
IQCODE, MOCA.
h. Screening for delirium, dementia and depression in older adults - nursing best practice guidelines.
i. Restraints.
j. Elder mistreatment assessment.
k. Falls prevention - Falls Efficacy Scale - international (FES-I), Modified Morse Fall Risk scale, Performance
oriented mobility assessment (POMA), Fall risk assessment scale (FRAT-up scale).
l. Communication - Hearing screening in older adult.
m. Care giver coordination - modified caregiver strain index (MCSI).
n. Activities of daily living - functional assessment - Barthel index.
o. Rehabilitative measures - Self efficacy for exercise scale (SEE scale).
APPENDIX-3
CLINICAL LOG BOOK FOR NURSE PRACTITIONER IN GERIATRIC NURSING (NPGN) PROGRAM
(Procedural Competencies/Clinical Skills)
Ist YEAR
+----------+-------------------------------------+----------+------+--------------------------+
| S.No. | Specific Competencies/Skills | Number | Date | Signature of the |
| | | Performed| | 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) | | | |
| | Topic: | | | |
| 4 | Dissertation (IInd year) | | | |
| | Topic: | | | |
| II | LEADERSHIP, MANAGEMENT AND TEACHING | | | |
| 1 | Preparation of staff patient | | | |
| | assignment | | | |
| 2 | Preparation of unit budget | | | |
| 3 | Preparation of staff duty roster | | | |
| 4 | Patient care audit in the unit | | | |
| 5 | Management of equipment and supplies| | | |
| 6 | Monitoring, evaluation and writing | | | |
| | report related to infection | | | |
| | control/adverse drug reaction | | | |
| 7 | Preparation of teaching plan and | | | |
| | media for teaching patients/staff | | | |
| 8 | Micro teaching/patient education | | | |
| | sessions | | | |
| 9 | Planning and conducting OSCE/OSPE | | | |
| 10 | Construction of tests | | | |
| III | HEALTH ASSESSMENT | | | |
| 1 | Comprehensive history taking | | | |
| 2 | Comprehensive geriatric assessment | | | |
| 3 | Focused physical examination | | | |
| | (System wise) | | | |
| 3.1 | Respiratory system | | | |
| 3.2 | Cardiovascular | | | |
| 3.3 | Gastrointestinal | | | |
| 3.4 | Nervous | | | |
| 3.5 | Genitourinary | | | |
| 3.6 | Endocrine | | | |
| 3.7 | Haematological | | | |
| 3.8 | Musculoskeletal | | | |
| 3.9 | Integumentary | | | |
| 3.10 | Sensory organs | | | |
| | a. Vision | | | |
| | b. Hearing | | | |
| 4 | Geriatric assessment | | | |
| 5 | Assessment of muscle power | | | |
| 6 | Gait assessment | | | |
| 7 | Nutritional assessment | | | |
| 8 | Fall risk assessment | | | |
| 9 | Functional assessment - Barthel | | | |
| | index | | | |
| 10 | Mini Mental Status Examination | | | |
| 11 | Pain assessment | | | |
| 12 | Pressure sore assessment | | | |
| 13 | Assessment and care of patients | | | |
| | with dementia | | | |
| 14 | Assessment and care of patients | | | |
| | with Parkinsonism | | | |
| 15 | Geriatric depression scale | | | |
| 16 | Mini cog test | | | |
| 17 | Timed up and Go test | | | |
| IV | PROCEDURES TO BE PERFORMED | | | |
| 1 | Residual urine measurement by | | | |
| | bladder ultrasound | | | |
| 2 | Cardiac monitoring | | | |
| 3 | Arterial BP monitoring | | | |
| 4 | Oropharyngeal airway | | | |
| 5 | Endotracheal suctioning | | | |
| 6 | Oral suctioning | | | |
| 7 | IV cannulation/therapy | | | |
| 8 | Oxygen therapy | | | |
| | a. Nasal cannula/Venturi/Simple | | | |
| | Face mask | | | |
| | b. NIV | | | |
| 9 | Care of tracheostomy | | | |
| 10 | Diet planning | | | |
| | a. Soft solid | | | |
| | b. Liquid diet | | | |
| 11 | Total Parenteral Nutrition | | | |
| 12 | Care of pressure sore | | | |
| 13 | Elderly rehabilitation | | | |
| | a. Eye care | | | |
| 14 | Exercise | | | |
| | a. Swallow | | | |
| | b. Speech | | | |
| | C. Brandt-Daroff | | | |
| 15 | Physiotherapy | | | |
| | a. Chest/Limbs | | | |
| 16 | Exercise | | | |
| | a. Isotonic exercise | | | |
| | b. Isometric exercise | | | |
| 17 | Care of patients on restraints | | | |
| | a. Physical | | | |
| | b. Chemical | | | |
| 18 | End of life care | | | |
| 19 | Counselling | | | |
| | a. Patient | | | |
| | b. Family | | | |
| 20 | Administration of IV drugs | | | |
| 21 | Intramuscular Injection | | | |
| 22 | Podiatric care | | | |
| 23 | Setting of ventilators | | | |
| 24 | Care of patient with | | | |
| | a. Ventilators | | | |
| | b. Infusion pump | | | |
| 25 | Home safety measures | | | |
| 26 | Pain management | | | |
| | a. Acute pain - visual analogue | | | |
| | scale | | | |
| | b. Chronic pain - WHO pain ladder | | | |
| 27 | Care of patient on | | | |
| | a. Cast | | | |
| | b. Splint | | | |
| | C. Traction | | | |
| 28 | d. Amputee | | | |
| 29 | Use of prosthesis/hearing aid | | | |
| 30 | Care of dentures | | | |
| 31 | Use of walkers | | | |
| 32 | Use of wheelchairs | | | |
| 33 | Assistive devices for ADL | | | |
| | THERAPIES | | | |
| 34 | Diversional therapy | | | |
| 35 | Cognitive stimulation therapy | | | |
| 36 | Group therapy | | | |
| | HEALTH EDUCATION | | | |
| 37 | Glucose monitoring | | | |
| 38 | Home care management of insulin | | | |
| 39 | Self-administration of insulin | | | |
| 40 | Metered dose use | | | |
| 41 | Therapeutic diets | | | |
| 42 | Foot care | | | |
| 43 | Vaccination | | | |
| 44 | Oxygen concentrators | | | |
| 45 | Portable suctioning | | | |
| 46 | Participation in Group Counselling | | | |
+----------+-------------------------------------+----------+------+--------------------------+
* - When the student is found competent to perform the skill, it will be signed by the preceptor.
Students: Students are expected to perform the listed skills/competencies many times until they reach level 3
competency, after which the preceptor signs against each competency.
Preceptors/Faculty: Must ensure that the signature is given for each competency only after they reach level 3.
• Level 3 Competency denotes that the NP student is able to perform that competency without supervision.
• Level 2 Competency denotes that the student is able to perform each competency with supervision.
• Level 1 Competency denotes that the student is not able to perform that competency/skill even with supervision.
Signature of the Program Coordinator/Faculty
Signature of the HOD/Principal
IInd YEAR
+----------+-------------------------------------+----------+------+--------------------------+
| S.No. | Specific Competencies/Skills | Number | Date | Signature of the |
| | | Performed| | Preceptor*/Faculty |
+==========+=====================================+==========+======+==========================+
| I | ADVANCED COMPETENCIES | | | |
| 1 | Setting up, use and maintenance of | | | |
| | geriatric ward equipment | | | |
| 1.1 | Ventilator | | | |
| 1.2 | Defibrillator | | | |
| 1.3 | Pacemaker | | | |
| 1.4 | CRASH trolley | | | |
| 1.5 | CPAP/BiPAP machines | | | |
| 2 | Triage | | | |
| 3 | Family education and counselling | | | |
| 4 | Discharge/LAMA check list | | | |
| 5 | Medico-legal compliance | | | |
| 6 | End of life care | | | |
| 7 | After life care | | | |
| 8 | Infection control practices | | | |
| 9 | Standard/Universal precautions | | | |
| 10 | Disinfection/sterilization | | | |
| 11 | BLS and ACLS | | | |
| 12 | Preparation of policies/standards/ | | | |
| | protocols in ICU | | | |
| 13 | Administration of medication | | | |
| | (includes standing orders) | | | |
| | Ist & IInd Year | | | |
| 13.1 | Catecholamines (calculation, | | | |
| | titration & administration) | | | |
| | a. Adrenaline | | | |
| | b. | | | |
| 13.2 | Antidysrhythmic | | | |
| | a. Amiodarone | | | |
| | b. | | | |
| 13.3 | Adrenergic agent | | | |
| | a. Ephedrine | | | |
| | b. | | | |
| 13.4 | Bronchodilators | | | |
| | a. Aminophylline | | | |
| | b. Deriphylline | | | |
| | C. | | | |
| 13.5 | Analgesics | | | |
| | a. NSAIDS | | | |
| 13.6 | Antihistamine | | | |
| | a. Avil | | | |
| 13.7 | Antihypertensives | | | |
| | a. Glyceryl Trinitrate | | | |
| | b. | | | |
| 13.8 | Corticosteroids | | | |
| | a. Hydrocortisone | | | |
| 13.9 | Antiepileptics | | | |
| | a. Levetiracetam | | | |
| | b. | | | |
| 13.10 | Muscle relaxants & Sedatives | | | |
| | a. Valium | | | |
| | b. | | | |
| 13.11 | Antipyretics | | | |
| 13.12 | Anti Parkinson's disease | | | |
| | a. | | | |
| | b. | | | |
| 13.13 | Electrolyte and acid base correction| | | |
| | agents (Na, K, Cal, P, Mg, Fe) | | | |
| | a. Soda bicarbonate 8.4% | | | |
| | b. Soda bicarbonate 7.5% | | | |
| | C. Potassium chloride | | | |
| | d. 3% Normal Saline (sodium | | | |
| | chloride) | | | |
| | e. 0.9% Normal Saline (sodium | | | |
| | chloride) | | | |
| 13.14 | Anti-diabetic agents | | | |
| | a. Insulin | | | |
| | b. | | | |
| 14 | Management of Cardiovascular | | | |
| | Alterations | | | |
| 14.1 | Intravenous fluid administration | | | |
| | (Colloid/Crystalloid) | | | |
| 14.2 | Blood and blood product | | | |
| | administration | | | |
| 14.3 | Application of TED stocking | | | |
| 14.4 | Care of Patient on Pacemaker | | | |
| 15 | Management of Pulmonary Alterations | | | |
| 15.1 | Care of airway | | | |
| 15.2 | Laryngeal mask airway application | | | |
| 15.3 | Extubation | | | |
| 15.4 | Endotracheal/tracheal suctioning - | | | |
| | Open and closed | | | |
| 15.5 | Nebulization | | | |
| 15.6 | Care of patient with chest drainage | | | |
| | tube | | | |
| 15.7 | Care of patient on invasive | | | |
| | ventilation | | | |
| 15.8 | Non-invasive ventilation | | | |
| 15.9 | Connecting to ventilator | | | |
| 15.10 | Weaning from ventilator | | | |
| 15.11 | Use of T-tube and Venturi devices | | | |
| 15.12 | Weaning from tracheostomy | | | |
| 15.13 | Chest physiotherapy | | | |
| 16 | Management of Neurological | | | |
| | Alterations | | | |
| 16.1 | Sensory stimulation | | | |
| 16.2 | Consciousness/Coma status | | | |
| | monitoring | | | |
| 16.3 | ICP monitoring | | | |
| 17 | Management of Genitourinary | | | |
| | Alterations | | | |
| 17.1 | Care of patient on haemodialysis | | | |
| 17.2 | Initiating peritoneal dialysis | | | |
| 17.3 | Care of patient on peritoneal | | | |
| | dialysis | | | |
| 17.4 | Calculation of fluid replacement | | | |
| 17.5 | Bladder ultrasound | | | |
| 17.6 | Uroflowmetry | | | |
| 17.7 | Management of bladder incontinence | | | |
| | • Bladder diary/Timed voiding | | | |
| | • Condom catheterization | | | |
| | • Diaper use | | | |
| 17.8 | Pelvic floor Exercise (Kegel's | | | |
| | exercise) | | | |
| 18 | Management of Gastrointestinal | | | |
| | Alterations | | | |
| 18.1 | Estimation of dietary allowance | | | |
| 18.2 | Therapeutic diet planning | | | |
| 18.3 | Enteral nutrition - Gastrostomy/ | | | |
| | Jejunostomy feeding | | | |
| 18.4 | Administration of Parenteral | | | |
| | nutrition (TPN) | | | |
| 18.5 | Hypodermoclysis | | | |
| 19 | Management of Endocrine Alterations | | | |
| 19.1 | Insulin therapy (sliding scale & | | | |
| | infusion) | | | |
| 19.2 | Calculation, titration, and | | | |
| | administration | | | |
| 19.3 | Steroids-Calculation and | | | |
| | administration | | | |
| 19.4 | Foot assessment | | | |
| | Health teaching | | | |
| | a. Self-administration of insulin | | | |
| | b. Foot care | | | |
| 20 | Ordering Investigations | | | |
| 20.1 | ECG | | | |
| 20.2 | ABG | | | |
| 20.3 | Chest X-Ray | | | |
| 20.4 | Basic microbiology investigations | | | |
| 20.5 | Basic biochemistry investigations | | | |
| 21 | Ordering Procedures/Treatment | | | |
| 21.1 | Nebulization | | | |
| 21.2 | Chest physiotherapy | | | |
| 21.3 | Insertion and removal of urinary | | | |
| | catheter | | | |
| 21.4 | TEDS | | | |
| 21.5 | Surgical dressing | | | |
| 21.6 | Application of Ichthammol | | | |
| | Glycerine/Magnesium Sulphate | | | |
| | dressing for Thrombophlebitis/ | | | |
| | extravasation | | | |
| 21.7 | Pin site care for patients on | | | |
| | external fixators | | | |
| 21.8 | Isometric and isotonic exercises | | | |
| 21.9 | Hot and cold applications | | | |
| 21.10 | Digital evacuation | | | |
| 22 | Procedures Observed | | | |
| 22.1 | Gastroscopy | | | |
| 22.2 | Cystoscopy | | | |
| 23 | Field Visit | | | |
| 23.1 | Old age home | | | |
| 23.2 | Hospice centre | | | |
| 23.3 | Day care centre | | | |
| 23.4 | Geriatric club | | | |
+----------+-------------------------------------+----------+------+--------------------------+
* - When the student is found competent to perform the skill, it will be signed by the preceptor.
Students: Students are expected to perform the listed skills/competencies many times until they reach level 3
competency, after which the preceptor signs against each competency.
Preceptors/Faculty: Must ensure that the signature is given for each competency only after they reach level 3.
• Level 3 Competency denotes that the NP student is able to perform that competency without supervision.
• Level 2 Competency denotes that the student is able to perform each competency with supervision.
• Level 1 Competency denotes that the student is not able to perform that competency/skill even with supervision.
NOTE: 5-10% of procedures that are rare, can be practiced in skill lab and attained level 3 competency.
Signature of the Program Coordinator/Faculty
Signature of the HOD/Principal
APPENDIX-4
CLINICAL REQUIREMENTS FOR NURSE PRACTITIONER IN GERIATRIC NURSING PROGRAM
Ist YEAR
+----------+-------------------------------------------------------------+------+--------------------------+
| S.No. | Clinical Requirement | Date | Signature of the |
| | | | Preceptor/Faculty |
+==========+=============================================================+======+==========================+
| 1 | Clinical Seminar/Journal Club/Clinical Conference | | |
| 1.1 | *APN - Clinical pathway in specific clinical conditions/ | | |
| | Application of specific nursing theory (Clinical Seminar) | | |
| | Title of the topic: | | |
| 1.2 | *RA - Evidence search for geriatric nursing competencies | | |
| | (Clinical Conference/Journal Club) | | |
| | Title of the topic: | | |
| 1.3 | *LM&T - Trends in Leadership/Management/Teaching | | |
| | (Journal Club) | | |
| | Title of the topic: | | |
| 2 | Clinical Rounds (With Nursing staff, faculty, students) - | | |
| | Case/Clinical Presentation | | |
| 2.1 | Pathophysiology (Clinical Conditions) | | |
| | Name of the clinical condition: | | |
| 2.2 | Pathophysiology (Clinical Conditions) | | |
| | Case study (Written Report) | | |
| | Name of the clinical condition: | | |
| 2.3 | Pharmacology - Drug Studies (Drugs listed under Standing | | |
| | Orders) - written report of 5 presentations (Bedside | | |
| | Presentations) | | |
| | Name of the drug: | | |
| 2.3.1 | | | |
| 2.3.2 | | | |
| 2.3.3 | | | |
| 2.3.4 | | | |
| 2.3.5 | | | |
| 2.3.6 | | | |
| 2.3.7 | | | |
| 2.3.8 | | | |
| 3 | Interdisciplinary Clinical Rounds (With geriatrician) - | | |
| | 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 (Geriatric) - History & Physical | | |
| | Examination (Two written reports) | | |
| 3.2.1. | | | |
| 3.2.2. | | | |
| 3.2.3. | | | |
+----------+-------------------------------------------------------------+------+--------------------------+
*Advanced Practice Nursing - APN, Research Application - RA, Leadership, Management and Teaching - LM&T
Signature of the Program Coordinator/Faculty
Signature of the HOD/Principal
CLINICAL EXPERIENCE DETAILS - Ist YEAR
+---------------------------+-------------------+--------------------+--------------------------+
| Name of Ward/Clinical Unit| Clinical Condition| Number of days | Signature of |
| | | care given | Faculty/Preceptor |
+===========================+===================+===================+==========================+
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Signature of the Program Coordinator/Faculty
Signature of the HOD/Principal
IInd YEAR
CLINICAL REQUIREMENTS FOR NURSE PRACTITIONER IN GERIATRIC NURSING PROGRAM
+----------+-------------------------------------------------------------+------+--------------------------+
| S.No. | Clinical Requirement | Date | Signature of the |
| | | | Preceptor/Faculty |
+==========+=============================================================+======+==========================+
| 1 | Clinical Seminar/Journal Club/Clinical Conference | | |
| 1.1 | Foundations of Geriatric Nursing Practice (Clinical | | |
| | Conference) | | |
| | Title of the topic: | | |
| 1.2 | Geriatric Nursing - I (Clinical Seminar) | | |
| | Title of the topic: | | |
| 1.3 | Geriatric Nursing - I (Journal Club) | | |
| | Title of the topic: | | |
| 1.4 | Geriatric Nursing - II (Clinical Seminar) | | |
| | Title of the topic: | | |
| 1.5 | Geriatric Nursing - II (Journal Club) | | |
| | Title of the topic: | | |
| 2 | Clinical Rounds (with Nursing Staff, Faculty, Students) - | | |
| | Case/Clinical Presentation | | |
| | (Written reports are for submission) | | |
| 2.1 | Foundations of Geriatric Nursing Practice | | |
| | (Family Education/Counselling) (Written report) | | |
| | Title of the topic: | | |
| 2.2 | Foundations of Geriatric Nursing Practice (Clinical/Care | | |
| | Pathway) | | |
| | Title of the topic: | | |
| 2.3 | Geriatric Nursing - I (Clinical Presentation) | | |
| | Name of the clinical condition: | | |
| 2.4 | Geriatric Nursing - I (Case Study Report) | | |
| | Name of the clinical condition: | | |
| 2.5 | Geriatric Nursing - II (Clinical Presentation) | | |
| | Name of the clinical condition: | | |
| 2.6 | Geriatric Nursing - II (Case Study Report) | | |
| | Name of the clinical condition: | | |
| 2.7 | Drug Studies (Drugs listed under Standing Orders) | | |
| | Bedside Presentation (Five written reports) | | |
| | Name of the drug: | | |
| 2.7.1 | Name of the drug: | | |
| 2.7.2 | | | |
| 2.7.3 | | | |
| 2.7.4 | | | |
| 2.7.5 | | | |
| 2.7.6 | | | |
| 2.7.7 | | | |
| 2.7.8 | | | |
| 3 | Interdisciplinary Clinical Rounds (With geriatrician) - | | |
| | Case/Clinical Presentation | | |
| 3.1 | Geriatric Nursing - I (Clinical Presentation) | | |
| | Name of the clinical condition: | | |
| 3.2 | | | |
| 3.3 | | | |
| 3.4 | | | |
| 3.5 | (Case Study Report) | | |
| 3.6 | Geriatric Nursing - II (Clinical Presentation) | | |
| 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 - IInd YEAR
+---------------------------+-------------------+--------------------+--------------------------+
| Name of Ward/Clinical Unit| Clinical Condition| Number of days | Signature of |
| | | care given | Faculty/Preceptor |
+===========================+===================+===================+==========================+
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Signature of the Program Coordinator/Faculty
Signature of the HOD/Principal
APPENDIX-5
STANDING ORDERS
Nurse Practitioners are prepared and qualified to assume responsibility and accountability for the care of geriatric
patients. They collaborate with intensivists, 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:-
Catecholamines
1. Adrenaline
2. Vasopressin
Antidysrhythmic
3. Amiodarone
Adrenergic agent
4. Ephedrine
Bronchodilators
5. Aminophylline
6. Deriphylline
7. Tiova
Antihistamine
8. Avil
Antihypertensives
9. Glycerine trinitrate
Corticosteroid
10. Hydrocortisone
Antiepileptic
11. Levetiracetam
Sedatives & relaxants
12. Valium
Electrolytes & acid base correction agents
13. Soda bicarbonate 8.4%
14. Soda bicarbonate 7.5%
15. 3% Normal saline
16. 0.9% Normal saline
17. Antipyretics
18. Anti Parkinson's drugs
Repeat medications
19. Calcium supplements - Sandacol, Shelcal, Osteocalcium
20. Oral antidiabetic agents - Metformin, Glynase, Insulin
The following investigations and therapies may be ordered by the NPs
+-------------------------------------------------------------+-------------------------------------------------------------+
| Ordering Investigations | Ordering Therapies |
+=============================================================+=============================================================+
| • ECG | • Nebulization |
| • ABG | • Chest physiotherapy |
| • Chest X-Ray | • Distal colostomy wash |
| • Basic Biochemistry investigations - | • Insertion and removal of urinary catheter for female |
| Hb, PCV, TIBC, WBC Total, WBC differentials, | patients |
| ESR, Electrolytes, platelets, PT, aPTT, bleeding | • Test feeds |
| and clotting time, procalcitonin, D-dimer, | • TEDS |
| creatinine, HbA1c, AC, PC, HDL, LDL, TIG, | • Surgical dressing |
| Cholesterol total, HIV, HBsAg, HCV | • Starting and closing dialysis |
| • Basic Microbiology investigations - | • Application of Ichthammol Glycerine/Magnesium |
| blood samples for culture and sensitivity | Sulphate dressing for Thrombophlebitis/extravasation. |
| | • Pin site care for patients on external fixators |
| | • Isometric and isotonic exercises |
| | • Digital evacuation |
+-------------------------------------------------------------+-------------------------------------------------------------+
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 NPGN 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 NPGN students.
DR. T. DILEEP KUMAR, Chairman
[ADVT.-III/4/Exty./611/2024-25]
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