Blueprint Regional Examination for Nurse Registration CARICOM Countries
BLUEPRINT REGIONAL EXAMINATION FOR NURSE REGISTRATION
CARICOM COUNTRIES Developed: 1992 Revised: February, 2014
Caribbean Community Secretariat Turkeyen Georgetown, Guyana
Blueprint [for] Regional Examination for Nurse Registration [for] CARICOM Countries, Rev. ed. Š Caribbean Community Secretariat, 2015 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the publisher. Published by Caribbean Community (CARICOM) Secretariat Turkeyen, P.O. Box 10827 Georgetown, Guyana
ISBN 978-976-600-367-8 (Pbk) ISBN 978-976-600-368-5 (CD-Rom)
Endorsed by the Nineteenth Special Meeting of the Council for Human and Social Development (COHSOD) - Health, held at PAHO/WHO Headquarters in Washington, D.C., USA, 27-28 September 2014.
TABLE OF CONTENTS CONTENTS
PAGE
ACKNOWLEDGEMENT ........................................................................................................... iii BACKGROUND .......................................................................................................................... iv INTRODUCTION ........................................................................................................................ 6 PURPOSE OF BLUEPRINT ........................................................................................................ 7 RATIONALE FOR RENR ........................................................................................................... 8 PHILOSOPHY OF NURSING .................................................................................................... 9 THEORETICAL FRAMEWORK .............................................................................................. 13 NURSING DOMAINS………………………………………………………………………... 13 BROAD CONCEPTS………………………………………………………………………...
22
COMMON HEALTH PROBLEMS………………………………………………………….
23
CURRICULUM OUTLINE…………………………………………………………………..
25
COURSE DESCRIPTIONS ........................................................................................................ 26 REGIONAL EXAMINATION FOR NURSE REGISTRATION………………………
33
APPENDIX 1: APPLICATION OF THE NURSING PROCESS TO THE CLIENT WITH DIABETES MELLITUS…………………………………………………………………… 37 APPENDIX 2: COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES…………………………………………………… 43 APPENDIX 3: SAMPLE TABLE OF SPECIFICATION……………………………………
53
APPENDIX 4: PSYCHOMOTOR COMPETENCIES: CORE LIST OF NURSING SKILLS FOR SCHOOL - BASED ASSESSMENT………………………………………………………54 APPENDIX 5: CLINICAL SKILLS ASSESSMENT TOOLS: YEAR 111 - SIMPLE DRESSING …………………………………………………………………………………… 60 i
APPENDIX 6: CLINICAL SKILLS ASSESSMENT TOOLS: YEAR 111 - WARD MANAGEMENT……………………………………………………………………………….62 APPENDIX 7: CLINICAL ASSESSMENT TOOL: YEAR 111 - WARD MANAGEMENT, ACTIVITY - MANAGED CARE……………………………………………………………….64 APPENDIX 8: LIST OF CARICOM MEMBER COUNTRIES……………….…………........ 66 APPENDIX 9: LIST OF PARTICIPANTS…………………………………………….……….67 APPENDIX 10: REFERENCES………………………………………………………….……70
ii
ACKNOWLEDGEMENT
The revision of this Blueprint would not have been possible without the input of several organizations and individuals. - The Regional Nursing Body for its continued visioning of nursing within the CARICOM Region, and for the commissioning of the revision of the Blueprint for the Regional Examination for Nurse Registration (RENR). - The CARICOM Secretariat for the resources and guidance during the revision stages. - The General Nursing Councils of the Region for their interest and commitment to the process of Regional Examination for Nurse Registration (RENR). - The nursing faculties of the various educational institutions for their dedication to the process of nursing education and for their involvement in this initiative. - The technocrats who persevered to the realization of this document. - The secretary and support staff who laboured tirelessly to ensure the completion of the document.
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BACKGROUND During the 1980’s several initiatives were implemented to improve the standard and quality of nursing education within the CARICOM region. Schools of Nursing collaborated, under the aegis of the Pan American Health Organization (PAHO), to develop and implement a curriculum to guide the education of nurses within the basic nursing programme. Standards to guide the education and practice of nurses were developed and Schools of Nursing were evaluated to assess their effectiveness. These efforts encouraged some degree of networking and harmonization among divisions of nursing education within the region. The CARICOM Member States, after many years of planning and based on commonalities, introduced a Regional Examination for Nurse Registration (RENR) in 1993. These included common health problems, similarities in nursing education programmes, nursing practice and supporting infrastructures, and, a conscious need to enhance the effectiveness of nursing care available to the peoples of CARICOM territories. The Regional Nursing Body (RNB), the policy making body for nursing in the CARICOM states, had, as one of its priority objectives as far back as 1970, the development of a Regional Examination for Nurse Registration. A feasibility study was conducted during October and November of 1976, which established consensus among the thirteen (13) commonwealth Governments in the Region, in principle, to a Regional Examination for Professional Nurse Registration. A Workshop held at Dover, Barbados, in 1978 provided a document, which included common aspects of nursing considered essential for nurses seeking registration in the Region. The Dover Document formed the background material for the development of the Blueprint for the examination. There were subsequent activities in the further development of the Project. The General Nursing Councils met at the Ocean View Hotel, Barbados, in 1990 to develop strategies for the implementation of the examination. The representatives identified twenty-four (24) competencies as the scope of practice for all registered nurses wishing to practice nursing within the CARICOM Member states. The need for a common examination is now firmly undergirded by principles of the CSME in particular the concept of free movement. iv
Under the Canadian Nurses Association (CNA) sponsorship, the Canadian International Development Agency (CIDA) approved the funding of the Regional Nurse Registration Examination Project until 1985. Funding for subsequent Project activities were also provided by the Pan American Health Organization (PAHO), the CARICOM Secretariat and the participating countries of CARICOM. The original Blueprint, therefore, was the result of the activities of nurses of the Region who attended a series of workshops and meetings between November 1980 and 1991. The Blueprint highlighted the rationale for the Regional Examination. It also included the philosophy, goals, objectives, competencies and content outlines for nursing and the relevant supporting sciences. The Blueprint has been used to guide the conduct and content of the Regional Examination for Nurse Registration (RENR), since its inception in October 1993. The document has been revised to reflect the current realities. The Competencies for Nursing Practice were revisited in 2007 by the Regional Nursing Body and ratified by the General Nursing Councils of the Region. This revised Blueprint reflects the philosophy and theoretical framework for nursing education within the CARICOM Region, the major curriculum concepts and content for a B.Sc. Nursing undergraduate programme and the policy guidelines for conduction of the Regional Examination for Nurse Registration. The policy changes made during the period of implementation of the Regional Examination for Nurse Registration (RENR) 1993 – 2008, have been incorporated. The Blueprint is the property of the General Nursing Councils of the Region and is the reference document for the education and examination of nurses within the CARICOM Region.
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INTRODUCTION
The General Nursing Councils of the Region have the legal responsibility for nursing education and registration and are tasked with a number of activities critical to the successful education and practice of nurses within the Region. The Regional Examination for Nurse Registration (RENR) developed and administered in CARICOM since 1993 signified a significant milestone and similar standards of nursing education in the ten participating CARICOM countries. An evaluation of the Regional Examination for Nurse Registration (RENR) carried out in 2001 – 2003 recommended that the core curriculum should be revised and updated to meet the current needs for nursing education. This was predicated on a policy decision had been made to recognize the BScN as the entry level to nursing practice in CARICOM countries. This position was ratified by the COHSOD of CARICOM Ministers of Health in 2006. Additionally, the movement of nursing education programmes from hospital based to college/university based required changes in curriculum content and delivery. In the absence of a comprehensive curriculum review, this has resulted in inconsistencies. The Regional Nursing Body (RNB) recommended that the curriculum be revised and presented in a more modern, user friendly format based on regionally agreed standards, core competencies, and global standards for the initial education of professional nurses and midwives. The Regional Examination for Nurse Registration (RENR) is developed and administered, by the Nursing Councils (NCs) of CARICOM countries. The successful completion of the RENR enables the candidate to: 
Be eligible for registration with the Nursing Councils in CARICOM;
The nurse who is trained and registered in a country outside of CARICOM and/ the nurse who is trained and registered in a non- participating CARICOM territory will be eligible for registration after successful completion of the RENR in the participating CARICOM country and validation by the Nursing Council in which the nurse was initially trained and registered. (i)
Use of the designation specified in the nursing law which identifies the professional nurse e.g. Registered Nurse (RN) Registered General Nurse (RGN). 6
(ii)
Seek employment as a registered nurse at the beginning level of the nursing career.
(iii)
Have reciprocity for employment purposes in any RENR- participating CARICOM country.
The RENR process is guided by – (i)
The Blueprint, which is the principal document guiding the preparation and administration of Regional Examination for Nurse Registration within the CARICOM Region. The Blueprint sets out the rationale for a regional examination and includes the philosophy, goals, objectives, competencies, concepts and content outline as well as criteria for tables of specification, and policy guidelines for marking and scoring of the examination.
(ii)
The Administrative Manual, which guides the conduct of the examination and the technical aspects of the examination process.
(iii)
The student preparation guide designed to familiarise students with the structure of the RENR and preparation for the RENR.
(iv)
The Bachelor of Science Degree in Nursing (BSc.N.) Curriculum, developed by the Regional Nursing Body (RNB) to guide nursing education programmes within the Region.
(v)
PURPOSE OF THE BLUEPRINT
The purpose of this Blueprint is to provide guidelines from which curricula may be developed, implemented and evaluated and to harmonize nursing education programmes across the Region. The Blueprint also outlines the protocols to be followed throughout the examination process leading to the registration and licensure of nurses. OBJECTIVES OF THE BLUEPRINT The Blueprint for nursing education programmes in the CARICOM Region: 1.
Provides the basis for the conduct of the Regional Examination for Nurse Registration (RENR). 7
2. 3.
Delineates the critical elements and nursing competencies to be tested in the examination. Specifies nursing domains and relevant scientific content essential to the practice of nursing.
4.
Establishes the parameters and standards for the professional nurse examinations.
5.
Outlines the protocols to be followed for the conduct of the Regional Examination for Nurse Registration
6.
Categorizes common health problems within the CARICOM Region.
7.
Shows the inter-relationships of areas to be tested.
8.
Provides guidelines for the preparation, utilization and management of test items.
9.
Signals the training needs necessary for the application of testing and measurement in nursing education.
RATIONALE FOR THE RENR
The Regional Examination for Nurse Registration will achieve the following: 1.
Establishes a standardized format of testing and evaluating nursing students for nurse registration in the Region.
2.
Facilitates the development of a system for reciprocal registration of nurses in the CARICOM Region.
3.
Provides guidelines for the development, administration and marking of examinations.
4.
Provides data for evaluating Schools and Departments of Nursing Education within the CARICOM Community.
5.
Facilitates the development in a wide cross section of professional nurses in testing and evaluating competencies and expertise. 8
6.
Institutes a medium for continuing research in nursing education programmes within the CARICOM Region.
PHILOSOPHY OF NURSING
The Philosophy which guides the conduct and content of nursing education programmes within the CARICOM Community incorporates tenets from the philosophy of nursing and that of general education. The General Nursing Councils of the Region believe that: Health is a dynamic holistic process in which the individual or family interact with physiological, psychological, cultural and spiritual stimuli in order to achieve maximum potential. Health is also the actualization of inherent and acquired human potential through goal-directed behavior, competent self-care and satisfying relationships with others. Adjustments are made along a health –illness continuum as needed to maintain structural integrity and to effect harmony with the environment. Health Care is the process of assisting the individual, family and community to attain or maintain a state of optimum wellness or to adjust to a comfortable position on the health – illness continuum. It is a basic human right and a priority for individuals, families and communities. Health Care should be available, accessible, affordable, comprehensive, continuous, coordinated and delivered by a team of trained competent professionals. Health Care programmes must reflect the health priorities of the society, and must be delivered in a way that will benefit the greater majority of the citizens. Nurses are professionals who have completed a programme of education in a recognized educational institution and are qualified, registered and licensed to practice Nursing. The Nurse as a professional is capable of critical inquiry, sound clinical judgment and ethical decision- making. Nurses function independently and interdependently within a multi-disciplinary health team. Nursing is a practice – based discipline, built upon the contribution of many nurse theorists as well as inputs from several other scientific disciplines. Nursing makes a distinctive contribution to the maintenance and promotion of health of individuals, families, communities and nations. Nursing is administered through the use of the Nursing Process, which allows for critical thinking, progressive inquiry and informed decision making. Nursing practice integrates multiple roles 9
and functions, is committed to evidence based practice and is directed towards the achievement of optimal functioning of the patient/client.
10
Education is the process whereby individuals are taught to develop critical thinking skills in determining the realities of the universe and to harness those skills for the benefit of themselves and the society. Education is a life-long process that seeks to inculcate knowledge, skills and attitudes thus producing a change in behaviour. Nursing Education is based on scientific principles, provide a broad and sound foundation for the effective practice of nursing, and a basis for continuing development in nursing. This must of necessity focus on the common health problems within the Region and reflect the current evidence-based trends in nursing practice. Professional Nursing Education Programmes in the Region should be offered in tertiary education institutions, at the first-degree level and should prepare graduates who are competent clinical practitioners capable of providing leadership and management as well as professional reflection and visioning. The administration of these programmes should reflect the global standards for the initial education of professional nurses and midwives, and those developed by the Regional Nursing Body (RNB). Learning is a lifelong process of developing individual’s potential through a spirit of critical inquiry, conscious or unconscious change in behaviour. Learning is the result of a life-long, dynamic process by which the learner acquire new skills and or attitudes that can be measured, and can occur at anytime or in any place due to exposure to environmental stimuli. Learning is enhanced through collaborative interaction with other disciplines Learner brings unique and diverse knowledge and experiences that serve as a resource to the educational process. Learners are encouraged to be innovative, to challenge assumptions and be committed to the pursuit of knowledge. The pursuit of knowledge is the key thread that crosses the entire curriculum and will enable the learner to critically evaluate and integrate theory, research and current practice to foster lifelong growth.
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Teaching is a dynamic interactive process between the facilitator and the learner. It is a component of the educational process that is deliberate and intentional in communicating information to the learner in response to identified knowledge deficits. Teaching encourages learners to maximize their potential to create structures, and build relationships in their chosen field and to model different roles. Teachers are highly motivated individuals, engaged in the process of moulding others. They stimulate critical thinking, present competing explanations of social realities and assist learners to explore alternatives in a changing environment. Effective teachers continue their developmental process through in-service and continuing education. Teachers use dynamic, syndicate – based teaching/learning strategies which, offer opportunities to learners and teachers to explore the unknown and to consolidate and integrate previously acquired knowledge. Evaluation is a core facet of the teaching and learning process and should be conducted formatively and summatively and include the teacher, the learner and all other resources. Teaching and Learning Environment should provide optimal (physical, intellectual, spiritual and cultural) conditions for learning and facilitate the culture of scientific inquiry and embracing the principle of mutual respect.
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THEORETICAL FRAMEWORK
The Regional Examination for Nurse Registration (RENR) will be guided by contemporary conceptual models and theories of nursing as an art and a science (Example, Roy, Orem, Levine, Peplau, Watson, Leininger, Rogers). It will also focus on the delivery of care throughout the life cycle of man and at any point of the health – illness continuum. In this Blueprint the role of nursing is reflected as pivotal to the health and well being of individuals, families, communities, countries and Regions and is therefore the object of testing. The competencies for testing will be organized in keeping within the following seven domains, which serve as anchors of the nursing profession. These domains are: Nursing Practice, Professional Conduct, Health Promotion and Maintenance of Wellness, Nursing Leadership and Management, Communication, Clinical Decision-Making and Intervention and Professional Development.
NURSING DOMAINS DOMAIN 1: NURSING PRACTICE Descriptor Refers to the holistic approach and treatment of people as human beings of value and worth and the demonstration of caring behaviours and attitudes by the nurse. It also includes the nurse’s ability to undertake nursing care within the framework of informed consent. Nursing care should be based on the best available evidence and on an appropriate repertoire of skills indicative of safe and effective practice. In addition, the nurse is required to demonstrate current knowledge of health care trends, and a sense of accountability for practice in accordance with health and nursing legislation. In so doing, the nurse should be sensitive to, and demonstrate respect for patient rights.
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DOMAIN 2: PROFESSIONAL CONDUCT Descriptor Relates to the manner in which the nurse demonstrates professionalism which is in keeping with the Code of Ethics of the International Council of Nurses (ICN) and the Regional Nursing Body and with national nursing legislation and regulations. These guidelines direct the professional and inter-professional relationships that are established during the scope and functions of nursing practice. It also emphasizes the attitude of the nurse to patient care and the need for each nurse to display a professional manner even in challenging situations.
DOMAIN 3: HEALTH PROMOTION and MAINTENANCE of WELLNESS Descriptor Health promotion, disease, and injury prevention across the lifespan are essential elements of entry level nursing practice at the individual and population levels. Health promotion includes assisting individuals, families, communities, and populations to prepare for and minimize health consequences and maintain wellness. Population-focused nursing involves identifying determinants of health, prioritizing primary prevention when possible, and using available resources to assure the best overall improvement in the health of the population. Health promotion interventions prevent the escalation of diseases and assists with the understanding of the link between health promotion strategies and health outcomes. Collaboration with other healthcare professionals and populations is necessary to promote healthy behaviors that improve population health.
DOMAIN 4: NURSING LEADERSHIP AND MANAGEMENT Descriptor Relates to use of leadership skills to adequately carry out management functions in the health care environment. The health care environment includes patient care units in a variety of settings at institutional or community level. 14
Nursing leadership and management also involves the application of the principles of decision making, problem solving and conflict resolution to facilitate a work environment that is supportive to healthy patient outcomes. Integral to evaluation in nursing management are continuous quality improvement systems along with revision and development of practice policies to enhance patient care. DOMAIN 5: COMMUNICATION Descriptor Refers to the processes whereby meanings are assigned and conveyed to others to create shared awareness and understanding of phenomena. It includes the ability to recognize and eliminate barriers, and to utilize appropriate methods of effective communication. Nursing practice utilizes constant communication between the nurse and the patient, the family, communities and the interdisciplinary team. Communication is inherent in the establishment and continuation of the therapeutic nurse-client relationship to facilitate provision of care.
DOMAIN 6: CLINICAL DECISION-MAKING AND INTERVENTION Descriptor Refers to the mental processes of reaching agreements on the selections of courses of actions, their rationales and outcomes. Clinical decision making is context specific and changes according to client and practice setting circumstances. These decisions are made with available data independently or in collaboration with the inter-disciplinary team, the patient/client and the family. Critical thinking is integral to decision-making and includes the activities of organizing assessment information, recognizing patterns and compiling evidence to support the conclusions drawn. DOMAIN 7: PROFESSIONAL DEVELOPMENT
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Relates to self-appraisal and professional development as well as reflection on practice, feelings and beliefs and their consequences for nurse/client relationships and interactions. This also reflects the need for planning for life-long learning and understanding the value of evidence based findings for competent nursing practice. It ensures that the nurse develops his or her professional practice in accordance with the health needs of the population and the changing patterns of disease and illness. These domains give rise to the competencies expected of the practitioner in the delivery of nursing care. The competencies are used as standards to assess the extent to which nurses can function effectively. PROGRAMME COMPETENCIES Nursing education programmes within the CARICOM Community should be focused on ensuring that there graduates achieve the desired standards in the competencies established by Regional Nursing Body (RNB). The Regional Examination for Nurse Registration (RENR) therefore, utilises these competencies as the framework for the development of test objectives and items. DOMAIN
UNITS OF COMPETENCE
DOMAIN 1
1.
Integrates nursing and health care knowledge, skills and attitudes to provide safe, ethical and effective nursing care
2.
Utilizes the nursing process as the framework for providing safe ethical, and effective nursing care
3.
Practises within national, regional & international legal and regulatory frameworks for nursing
4.
Demonstrates knowledge of the influence of organizational and societal culture on the provision of health and nursing care.
5.
Demonstrates sensitivity and respect for diversity in personal choices, practices and beliefs including religion, sexual orientation, gender and culture in patient/client and family interactions
Nursing Practice
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DOMAIN
UNITS OF COMPETENCE 6.
Demonstrates caring attitudes and behaviour in delivery of nursing care.
7.
Selects valid and reliable assessment tools and techniques to collect required data to inform the delivery of nursing care.
8.
Collects data systematically regarding the health and functional status of individuals, families and communities through appropriate interaction, observation and measurement.
9.
Interprets data accurately to inform selection of nursing interventions in the delivery of patient care.
10.
Establishes priorities of care based on the needs of individuals, families and communities.
11.
Demonstrates the safe application of knowledge and skills required to meet the needs of patients/clients within current scope of practice.
12.
Collaborates with the interdisciplinary health care team, patients/clients, families and significant others, when appropriate, to review and monitor the plan of care.
13.
Utilizes information systems and technology to manage nursing and health care data during the delivery of patient/client care.
14.
Demonstrates scientific rigor in using research to solve problems and address issues in nursing and health care delivery settings.
15.
Takes action on actual and potential safety risks to clients/patients, self or/and others. 17
DOMAIN
UNITS OF COMPETENCE 16.
Domain 2
1.
Professional Conduct
Integrates organizational policies, best-practice guidelines and professional standards in the performance of all nursing roles and functions. Delivers safe, competent and ethical care that is consistent with ICN and RNB codes of ethics and national nursing legislation.
2.
Practices within own scope of knowledge and skill.
3.
Respects the roles and responsibilities of the other members of the health care team.
4.
Demonstrates accountability for nursing decisions and actions.
Domain 3
1.
Utilizes the Primary Health Care Approach in the delivery of health care.
Health Promotion and Maintenance of Wellness
2.
Assists the client /patient to understand the link between health promotion strategies and health outcomes across the life cycle.
3.
Utilizes evidence-based practices to guide planning and implementation of health education and health promotion activities.
4.
Assesses health/illness beliefs, values, attitudes, and practices to develop health promotion strategies for primary health care to individuals, families, and communities.
5.
Collaborates with the interdisciplinary health care team and patient/client to implement intervention plans that incorporate the determinants of health and available resources in the delivery of comprehensive nursing care.
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DOMAIN
Domain 4
Nursing Leadership and Management
UNITS OF COMPETENCE 6.
Uses an ethical framework to evaluate the impact of social policies on health care, especially for vulnerable individuals, families and communities.
1.
Utilizes management theories and leadership styles to carry out the activities of planning, organizing, controlling and evaluating the clinical work environment.
2.
Demonstrates leadership and management skills by adequately delegating responsibilities in planning the activities related to a selected clinical work environment.
3.
Promotes collaborative practice through the application of the principles of decision making, problem solving and conflict management among the health care team to facilitate the effective operation of the work environment.
4.
Manages resources to provide safe, efficient and ethical nursing care.
5.
Utilizes the principles of change to respond to the health care environment and nursing practice.
6.
Integrates Quality Improvement principles and activities into nursing practice to promote quality care.
7.
Participates in the analysis, development and implementation and evaluation of clinical practice and policies that guide the delivery of care.
8.
Participates in providing learning opportunities for nursing students to attain required competencies.
9.
Develops long and short-term goals which reflect 19
DOMAIN
UNITS OF COMPETENCE clients needs and national priorities for health care.
Domain 5 Communication
Domain 6
10.
Assesses the health care and emergency preparedness needs of a defined population
11.
Uses clinical judgement and decision-making skills in providing appropriate and timely nursing care during disaster, mass casualty and emergency situations.
12.
Coordinates efforts to build, sustain and improve capacity to respond to disasters
1.
Articulates the roles and responsibilities of a professional nurse in fostering therapeutic relationships with individuals and groups in the provision of quality nursing care.
2.
Utilizes appropriate communication and interpersonal skills to engage in, develop and disengage from therapeutic relationships with individuals and groups.
3.
Utilizes effective communication to influence interpersonal relationships that occur in the context of delivering nursing care.
4.
Acknowledges the boundaries of a professional caring relationship by demonstrating appropriate communication and interpersonal relationship skills.
5.
Demonstrates sensitivity when interacting with and providing information to patients/clients.
6.
Utilizes established communication protocols to disseminate information related to health care activities.
1.
Utilizes critical thinking skills and professional judgment to inform decision-making in the 20
DOMAIN
Clinical Decision Making and Intervention
Domain 7 Professional Development
UNITS OF COMPETENCE delivery of health care. 2.
Incorporates evidence from research, clinical practice, client preference to inform clinical decision-making
3.
Applies bio-psychosocial provision of nursing care.
4.
Provides information to enable patients/clients to make informed choices and to practice self care skills.
5.
Demonstrates sound clinical decision making which can be justified even when made on the basis of limited information.
6.
Evaluates the effectiveness of interventions using appropriate methodologies.
1.
Identifies one’s own professional development needs by engaging in reflective practice in the context of lifelong learning.
2.
Develops a personal development plan which takes into account personal, professional and organizational needs.
3.
Takes action to meet identified knowledge and skills deficit likely to affect the delivery of care within the current sphere of practice.
4.
Maintains membership and participates professional nursing organizations.
5.
Participates in continuing education programmes to keep pace with the changing nursing and healthcare environment. 21
knowledge
in
the
nursing research
in
The Blueprint identifies the following broad concepts: 1.
2.
Life Cycle The Blueprint identifies the Life Cycle using the following age groups: -
Neonatal
- 0 -28 days
-
Infant Toddler and Pre-school School Child Adolescent Young Adult / Childbearing Family Adult Elderly
-
29 days to 1 year 1year – 4 years 5 – 11 years 12 – 19 years 20 - 44 years 45 – 64 years 65 and years older
Nursing Process The Nursing Process is the scientific methodology used by nurses to deliver nursing care and consists of the following phases: - Assessment - Nursing diagnosis - Planning - Implementation - Evaluation Appendix 1, depicts the application of the Nursing Process to the care of a client with Diabetes Mellitus.
3.
Basic Needs Basic needs are common to individuals at all stages of the life cycle. Satisfaction of these needs is essential for physiological and psychosocial well-being. For the purposes of the Blueprint, the needs identified are – a.) Physiological - Oxygen - Nutrition - Elimination - Activity, Rest, Comfort - Sexuality - Safety and Security
22
b.) Psychosocial - Love and Belonging - Self-esteem - Self-actualization 4.
Factors Affecting Needs Satisfaction These are conditions that bring about a change in man’s health status. There are four factors, namely: - Biological - Psychosocial - Lifestyle - Health care organizations
5.
Leadership and Management The Registered Nurse/Midwife is expected to perform independent, interdependent and dependent functions in the delivery of care to patients at all levels of the continuum. This will require the utilization of effective principles of leadership and management skills through effective planning, delegation, decision making, advocacy and assertiveness in the adoption of their roles.
COMMON HEALTH PROBLEMS These health problems are outlined in the Caribbean Cooperation for Health Document Health problems are conditions which result from needs interferences. For purposes of the Blueprint, the health problems are categorized according to the lifecycle (see Appendix 2):
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B. Classification of Maladaptive States Congenital Defects of structure and/or functions existing at, or appearing after birth. Genetic Defects of structure and/or functions existing at, or appearing after birth due to disorders of genes/chromosomes. Infectious/Inflammatory The reaction of the body to toxins and invasion by microorganisms. Infestations Invasion of the body by microbes and parasites Allergic/Immunological Abnormal reaction of the body to the entry of foreign substances. Neoplastic Benign or malignant proliferation of cells. Accident/Trauma Damage to tissues resulting from injuries. Metabolic / Nutrition / Endocrine Changes which results from absence, decrease / excess of hormones, enzymes and nutrients. Degenerative Disturbances due to deterioration in cellular structures and functions. Psychosocial/Psychiatric Disturbances characterized by distorted social, emotional and / or intellectual behaviour. Environmental Imbalances in the environment. Health Infrastructure Types and availability of health and health-related services and human resources. 24
CURRICULUM OUTLINE
The courses to be offered in the Bachelor of Sciences Nursing Programme in the CARICOM Region will comprise the following – COURSES OFFERED PRE NURSING COURSES PNC 101 Anatomy PNC 102 Physiology PNC 103 Introduction to Sociology PNC 104 Introduction to Psychology PNC 105 Medical Microbiology PNC 106 Foundations of Chemistry PNC 107 Patho-physiology PNC 108 Introduction to Pharmacology PNC 109 Nutrition PNC 110 Health Promotion and Maintenance of Wellness PNC 111 Biochemistry PNC 112 Epidemiology
NURSING COURSES NC 201 Nursing Professionalism NC 202 Nursing Process NC 203 Health Assessment NC 204 Caring for the Child-Bearing Family NC 205 Adult Health Nursing Part 1- 20 – 64 years NC 206 Community Nursing NC 207 Nursing Care - 0 -28 days and1 Month – 19 years NC 208 Adult Health Nursing II – 20 – 64 years NC 209 Mental Health Nursing NC 210 Nursing Research NC 211 Nursing Care of the Older Person Part 11 – 65 years and over NC 212 Specialized Nursing NC 213 Nursing Management NC 214 Nursing Leadership NC 215 Nursing Clinical Elective NC 216 Nursing Practicum
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INSTITUTIONAL REQUIREMENTS IR 301 Fundamentals of Communication IR 302 Information Technology IR 303 Statistics
ELECTIVE COURSES: EC EC EC EC
304 305 306 307
Foreign Language (French or Spanish) Caribbean Society and Culture Public Speaking/Creative writing Trans-cultural Nursing
COURSE DESCRIPTIONS
The course descriptions will give rise to the content and of the curriculum and the examinations. PNC 101 Anatomy This course focuses on the human anatomy in its gross and microscopic forms and the relationship of anatomical structures to one another. The course utilizes a cell to tissue to organ to system approach and shows the relationships of the parts to the whole. The student will appreciate the structure and formation of the human body. PNC 102 Physiology This course focuses on the physiological functioning of the human body. The student will relate the physiology to anatomy along the life cycle. The student will appreciate man as a functional being and will integrate critical thinking and evidenced based knowledge with content from other courses to manage care for individuals. PNC 103 Introduction to Sociology This course introduces the student to elements of sociology, which includes the study of culture, social institutions and social groups. The emphasis on these elements will enable the student to appreciate how social forces influence group behaviour and its resultant effects on health.
26
PNC 104 Introduction to Psychology This course focuses on the individuality of man and the reasons for his perceptions, opinions and preferences. It explores the diversity and contemporary approaches in psychology, schools, history, psychological tests and ethical issues. The course enables the student to accept the uniqueness of patients / clients. PNC 105 Medical Microbiology This course introduces the student to the history of microbiology, eukaryotic and prokaryotic cell structure and taxonomy. It also covers the diversity of microbes, as well as their nutritional needs growth habits. In addition, the course focuses on the control of microbes by physical and chemical agents, microbial ecology, pathogenicity and epidemiology, preventing nosocomial infections, human defenses against infectious diseases and the major infectious diseases of humans. PNC 106 Foundations of Chemistry This course provides an overview of chemistry, including atomic structure, metric unit conversions, chemical nomenclature, the mole concept, stereochemistry chemical reactions, physical behaviours of gases, solutions, and acid-base theory. It is designed for learners with little or no chemistry background. PNC 107 Pathophysiology This course is the study of the structural and physiological changes occurring in the body as a result of disease processes. It justifies health status by offering explanations and explorations of alterations in body structure and functions and resultant clinical manifestations. PNC 108 Introduction to Pharmacology This course focuses on the role of drugs and other treatment modalities in health care. After examining the principles of pharmacology, the course explores the uses, purpose, actions, side effects and contraindications of drugs. Nurses are encouraged to assume responsibility for the management and safety of drugs within their charge. PNC 109 Nutrition This course introduces students to the principles of human nutrition and current dietary trends. Students will be able to utilize the information from this course to assist clients across the life cycle to make dietary choices that will promote health. 27
The course will sensitize students to safe food practices which they should model for society. PNC 110 Health Promotion and Maintenance of Wellness This course provides students with knowledge of health promotion, illness prevention, health maintenance and related strategies as integral components of health care delivery. It examines the impact of physical, psychosocial, environmental, and life style factors that influence health and explores Primary Health Care as the approach utilized in providing care to individuals, families and communities PNC 111 Biochemistry This course is designed to provide a comprehensive introduction to the Biochemistry of the human body, in recognition that physiological functions are the consequence of regulated chemical reactions occurring at the cellular level. It will enable students to relate the knowledge and understanding of biochemistry of illness and wellness as part of their preparation for providing nursing care. PNC 112 Epidemiology This course introduces the student to the key concepts of Epidemiology. It examines the modes of disease transmission and prepares the student to perform the nurse’s role in applying Epidemiology to health care provision. Students will be guided in the identification of sources of data, the use of appropriate measures of calculations, the analysis and interpreting of data and the application of findings to infection prevention and control. NC 201 Nursing Professionalism This course explores the historical, philosophical, scientific, ethical and legal bases for nursing practice. The principles, concepts and theoretical framework presented in this course provide a foundation for successive nursing courses. It examines nursing as a profession and encourages nurses to display the appropriate attitudes and aptitudes necessary to effect the role of Registered Nurse. NC 202 Nursing Process In this course the student adopts a scientific approach to nursing care of individuals, families and communities. They utilize critical inquiry skills to assess patients and clients through in-dept analysis of the subjective and objective data 28
available. The student then develops plans of care by formulating Nursing Diagnoses, and objectives of care. Appropriate interventions are selected and implemented. Outcomes are measured to ensure effectiveness of care. The student integrates this methodology through-out his or her practice and incorporates cognitive, inter-personnel, ethical and legal considerations into practice for safe and effective patient care. NC 203 Health Assessment This course utilizes the knowledge of integrated health information combined with the skills acquired in this course to assist the nurse to understand the concept of wellness to illness. This course encourages the nurse to master investigative procedures used in nursing and health care. The nurse uses a systems approach to examine the normal physical characteristics of man as well as deviations, which may manifest during illness. NC 204 Caring for the Child-bearing family This course examines the health care experiences of the childbearing family (including the father and siblings) during pregnancy, delivery and post partum. It provides knowledge and understanding of the father’s role and of the nursing management of the mother and child during the antenatal period, pregnancy, delivery and post-partum. The course also examines the evolution of nursing of the childbearing family, statistical indices related to birth and infant death rates, the family planning function and patient rights. NC 205 Adult Nursing I 20 – 64 years This course focuses on the care of the adult between the ages of 20 – 64 years with common acute and chronic maladaptive states. The emphasis will be on providing holistic care and the nursing process will be applied to plan, implement and evaluate nursing care. The course will seek to cover mainly the common health problems of the region and will include topics of all pathologies. NC 206 Community Nursing This course builds on the foundation provided in the Health Promotion and Maintenance course in year one. It combines the principles and skills of support courses and nursing practice to promote and preserve the health of communities. Areas of focus include the optimization of the Primary health Care approach and the implementation of programmes and strategies to reduce the cost burden of common communicable and non- communicable diseases on the communities. 29
NC 207 Nursing Care - 1 month – 19 years This course is a comprehensive introduction to the field of Paediatric nursing and provides the nurse with the theory and skills necessary to care for children during adaptation and mal-adaptation. The nursing process framework is used for examining individuals from infancy through adolescence. The content is examined in the context of individual, societal, cultural, psychological and physical factors. The clinical component will focus on the delivery of nursing care that is adapted to the unique health and developmental needs of children and their families. Health promotion, risk reduction and disease prevention will be emphasized. NC 208 Adult Nursing II – 20 – 64 years This is the second course to address disorders of the adult. The course focuses on the care of the adult between 20-64 years with common acute and chronic maladaptive states. The emphasis will be on providing holistic care and the nursing process will be applied to plan, implement and evaluate nursing care. Topics include musculoskeletal disorders, nervous disorders, sensory disorders, reproductive disorders, sexually transmitted infections and disorders of the integumentary system. NC 209 Mental Health Nursing This course focuses on individuals and families throughout the life span who are experiencing varying states of mental health. The factors affecting the mental health of individuals are examined within the context of the family and the community. The nurse /patient relationship is emphasized as the foundation for communication and therapeutic nursing interventions. Collaboration with other health team members and/or community resources is explored as a way to address the needs of the individual and family, using various treatment modalities. NC 210 Nursing Research This course will seek to strengthen the body of knowledge in Nursing. Students are taught to apply research methodology to nursing practice. Students will analyze the scientific merit of quantitative and qualitative research reports with an emphasis on application to and implication for evidenced based nursing practice as it relates to primary, secondary and tertiary prevention.
30
NC 211 Nursing Care of Older Persons - 65 Years and Over This course introduces the student to the study of gerontology. It is designed to focus the student on the needs of the elderly in states of adaptation and maladaptation. It highlights the basic needs of the elderly and specifies nursing interventions, which may be necessary to maintain and promote adaptation. It also focuses on factors that disrupt biological and psychological needs, based on actual and potential health problems of the elderly in a variety of environments and health care delivery systems. NC 212 Specialised Nursing This course examines the goals and objectives, organization, structure, and principles, which guide the care and management of patients in the specialized units, namely the operating theatre, recovery room, intensive care and ophthalmic unit and the accident and emergency department. Trauma management, disaster preparedness and emergency management are also covered in this course. NC 213Nursing Management This course guides the student in the development of management skills required by professional nurses in management roles. The student will be expected to use critical thinking and decision- making skills while developing experiences in planning, organizing, directing and evaluating care delivered to individuals and families in a variety of settings. The student will assume the various roles of team leader, change agent, patient advocate, teacher, counselor and problem- solver. NC 214 Nursing Leadership This course prepares the student for policy making and supervisory functions. It highlights issues that impact the profession of nursing. Students are exposed to strategies, which will facilitate their role as advocates, lobbyist and change agents for patient care and the profession of nursing. Professional and ethical principles to guide nursing conduct are threaded throughout this course. This course also highlights emerging professional leadership roles in nursing, health economics, health policy and political activism. NC 215 Nursing Clinical Elective This course is designed to offer the students additional learning opportunities and experiences in selected specialist areas of the programme. The course is mainly clinical in nature. The student is expected to choose one clinical specialty as partial 31
fulfillment for the course. Clinical electives are offered in Paediatrics, Medical Nursing, Surgical Nursing, Mental Health Nursing, Community Nursing, Family Centered Nursing, and Specialized Nursing. NC 216 Nursing Practicum This course synthesizes all previously learned knowledge, integrating the competencies of all domains, major concepts and threads into the single discipline of Nursing. Within an assigned clinical setting, nurses will utilize appropriate theories, Systems and/or models, use critical thinking skills and evidence based practice, coupled with the application of appropriate caring interventions, critical decision- making and leadership and management to achieved improved patient outcomes. The following are institutional courses. IR 301 IR 302 IR 303
Fundamentals of Communication Information Technology Statistics
Electives EC 304 EC 305 EC 306 EC 307
Foreign Language Caribbean Society and Culture Public Speaking/Creative Writing Trans-cultural Nursing
32
REGIONAL EXAMINATION FOR NURSE REGISTRATION
The Regional Examination for Nurse Registration (RENR) is a Criterion Referenced examination. Number of exam papers The RENR will consist of Paper 1 and Paper 2. Each paper may contain items from any or all of the domains providing that all of the stipulated coverage, weighting of the domains, phases of the nursing process and levels of the cognitive domains will be maintained. The Examination Committee will be responsible for producing the detailed Table of Specifications for each examination. GUIDELINES FOR DEVELOPING TABLE OF SPECIFICATION
The weight for each specification in the examination shall be as follows: A. Nursing Domains
Nursing Domains
Exam Weight
Number of Items
Nursing Practice. Professional Conduct Health Promotion and Maintenance of Wellness Nursing Leadership and Management Communication Clinical DecisionMaking and Intervention Professional Development TOTAL
30 10
60 20
10
20
15
30
10 20
20 40
5
10
100 %
200
33
B.
Cognitive Levels Each examination paper will reflect the Cognitive Levels adapted from Bloom’s Taxonomy as follows:
Knowledge/Comprehension (20%) Refers to the ability to recall previously learned material and understand its significance. It goes beyond mere knowledge of factual information, principles and concepts and includes the ability to interpret data and information that will be encountered in the environment in which the entry-level nurses will function. Application (50%) Refers to the entry-level nurses’ ability to use what they have learnt in novel, realistic situations. It includes application of rules and regulations, methods, nursing principles and theories in the provision of safe and ethical nursing care to patients. Analysis/Synthesis and Evaluation (30%) Encompasses critical thinking and problem solving and refers to the ability to determine priorities, to distinguish between relevant and irrelevant data, and to arrive at and be able to justify decisions and make justifications based on consideration of all the available evidence in the patient care situation. Affective and Psychomotor Items reflecting both the affective and psychomotor domains may be reflected in the written examination, but are not stipulated in the table of specifications The affective domain will be reflected in the evaluations presented to the General Nursing Council at least four (4) weeks prior to the examination. The competency level of the Psycho-motor skills will be assessed during the ongoing clinical assessments throughout the training programme and the final Nursing Council standardized clinical (practical) examination. Suggested competency skills for years one through to four are included (appendix 4) to this 34
document. Examples of checklist to guide the assessment of competencies constitute appendices 5 and 6 of the document. C. Life cycle Each age group will receive equal weighting on each examination paper, since it is necessary for professional nurse to be knowledgeable in all areas. D. Basic Needs The examination will address all the needs of man, since they are common to individuals at all stages of the life cycle. i. ii. iii. iv. v.
E.
Physiologic Needs: Oxygen, Nutrition, Elimination, Rest, Activity and Comfort, Sexuality Safety and Security ( internal and external factors) Love and Belonging (isolation, separation, anxiety, depression etc.) Self Esteem ( perception of self, body image) Self-Actualization
Nursing Process
The examination will include items on all five phases of the Nursing Process namely, Assessment, Nursing Diagnosis, Planning, Implementation and Evaluation.
F.
Common Health Problems All categories of health problems should be tested in each examination. The emphasis placed on a specific category will relate to the prevalence of health problems within the Caribbean Region. Major emphasis will be placed on the following categories:
Infectious / Inflammatory Neoplastic Accident / Trauma Metabolic / Nutrition / Endocrine Immunological Degenerative Psychosocial / Psychiatric Environmental 35
The following categories will also be examined:
Congenital Genetic Infestations Allergic
36
Appendix 1 Example: Application of the Nursing Process to the Care of a client with Diabetes Mellitus
Assessment 1)
Biographic Data Age Family History
2)
Physiological i. Oxygen Peripheral circulation Vital Signs Hx of hypertension or cardiovascular disease ii. Nutrition iii.
Weight / Height ratio Fluid intake Appetite Dietary practices Hydration Dental health
Elimination
Glycosuria Voiding pattern Urine volume Bowel habits
37
iv.
Rest, Activity and Comfort
v.
Gait (pain when walking) Exercise (tolerance (dizziness) Sleep patterns
Sensory Stimulation Sensorium Visual acuity Tactile sensation Sexuality Pruritis Sexual Activities Body Image – Hair loss, Vaginal Discharge
vi.
Safety and Security
3)
Psychosocial i. ii. iii. iv. v.
4)
Self-concept Self-esteem Body image Love and belonging Family relationships Self-actualization Family income
Environmental
5)
Blood sugar levels [potential for injury] Condition of skin and Mucous membranes (any wound present, infection, problem with healing, lesions, rash).
Occupational hazards Housing and living conditions Environmental hazards
Lifestyle
Smoking habits Substance abuse Sporting and recreational activities Occupation
38
B. Planning Problem List: Actual
Potential
Decreased peripheral circulation Sensory alterations Sexual dysfunction Ineffective coping Imbalanced nutritional
Risk for injury Risk for infection Risk for impaired skin / tissue integrity Risk for complications (Kidney failure, hypoglycemic coma etc.)
Nursing Diagnostic Statements:
Imbalanced nutrition (less than body requirements) related to inadequate utilization of carbohydrates, proteins and fat as evidenced by change in weight, increased thirst / urination and hyperglycemia. Sexual dysfunction related to decreased vaginal lubrication / biochemical effects on energy, libido secondary to diabetes mellitus as evidenced by patient stating that she doesn’t have the feeling to engage in sexual activities and or he is unable to have or sustain an erection. Risk for impaired skin integrity related to decreased blood and nutrients to area / circulatory changes. Risk for infection related to compromised circulation / compromised host defenses secondary to diabetes mellitus. Risk for injury related to impaired sensory function (Vision , touch).
Critical Areas of Care
Diet Monitoring of Weight Monitoring of Glucometer Reading / Blood Sugar Foot Care
Expected Outcomes
Client will be able to maintain a GMR between 120 – 180 mg/dl or 3.5 -5.5 mmol. Client will have an improvement in sexual function. Client will maintain skin integrity. Client will be free from injury / complications. Client will have an increased level of knowledge. Client will have an increased level of coping skills.
Required Resources
Dip Sticks, GMR machine, strips and lancets / needles Hypoglycemic medication Educational materials.
39
Team Approach
B)
Doctor: Diagnoses, surgical and medical management. Nurse: Implementation of interventions, education, counseling. Nutritionist: Dietary and exercise counseling Podiatrist: Foot Care Ophthalmologist: Eye care Pharmacist: Supplying of Medication Physiotherapist: Exercising of limbs to promote circulation
Social worker
Spiritual advisor
Implementation 1.
Physiological i. Oxygen Monitor and record vital signs Monitor and record peripheral circulation ii. Nutrition Advice on: (s) Dietary management (required calories, meal distribution) iii. Elimination Urinalysis Monitor and record urine volume iv. Activity, Rest and Comfort Advise on activity programmes ensure adequate rest and sleep v. Sensory Stimulation control environmental stimuli vi. Sexuality Advise on genital hygiene seek counseling vii. Safety and Security Interpret diagnostic tests results Counsel on: o Drug therapy o General hygiene o Special care to feet, eyes, skin and nails. o Special care if surgery is warranted
40
2.
Psychosocial i. ii. iii. iv.
Love and belonging Trust Self-concept Self-Esteem Encourage family participation in care Encourage involvement in community affairs Suggest types of diversional therapies Suggest sources for financial assistance if necessary v. Self-Actualization
3.
Environmental Control environmental hazards
4.
Lifestyle
5.
Health Teaching / Counseling
6.
Modify lifestyle as necessary Develop new recreational interests Limit drug, alcohol and tobacco consumption
Condition and complications Management to foster self-care and self-reliance Urine testing Dietary therapy Drug therapy Care of feet, eyes, nails and skin Exercise Sexuality Prevention of infection Importance of follow-up Travel Blood sugar monitoring
Community Resources
Diabetic Clinics and Associations Referral services Coordination of continuity of care Follow-up services
41
C)
Evaluation 1. Achievement of expected outcomes. 2. Alleviation of problems.
42
Appendix 2 COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS CATEGORIES Birth – 4 years Intussusception Congenital/Genetic Syphilis Neonatal jaundice Cleft lip and palate Oesophageal atresia
5 – 11 years Scoliosis haemophilia
12 – 19 years →
Malformations → of reproductive organs and related structures
Pyloric Stenosis Hirschsprung’s disease Imperforate anus Talipes Hydrocephalus Spina bifida Heart conditions → Neonatal cataract Down’s syndrome meningocoele Sickle cell anaemia Genito-urinary malformations Physical disabilities
→
43
20-44 years
45 – 64 years
65 + years
→
→
→
→
→
→
COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS CATEGORIES Birth – 4
5 – 11 years
12 – 19 years
20-44 years
45 – 64 years
65 + years
years Infections /Inflammatory
Umbilical Infections Eye Infections Upper respiratory tract infections Bronchopneumonia H1N1 H7N9 Gastroenteritis Tetanus HIV/AIDS Skin Disorders Communicable diseases Dental Health Rheumatic Fever Meningitis
→ → →
→ →
→ →
→ →
→ →
→
→
→
→
→
→
→
→
→
→
→ → → →
→ → → →
→ → → →
→ → → →
→ → → →
→ →
→ →
→ →
→
→
→ → →
→ →
→ →
→ →
→ →
→ →
→ → →
→ → →
→ → Osteomyelitis → Acute → glomerulo nephritis S T D’s Urinary tract infections Pelvic Inflammatory Appendicitis Tuberculosis Ulcerative Colitis
44
→ → → →
COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS CATEGORIES Birth – 4 years
5 – 11
12 – 19 years
20-44 years
45 – 64 years
65 + years
years Accident / Trauma
Cot deaths Abuse Burns Fracture Poisoning Head Injuries Gun Shot Injuries Road Traffic Accidents Internal injuries Dismemberment Wounds Foreign Bodies Asphyxiation
→ → → → → →
→ → → → → →
→ → → → → →
→ → → → → →
→ → → → → →
→
→
→
→
→
→
→ → →
→ → →
→
→ → → Abortions Ectopic
→ → → → → → → Industrial accidents
→ → → →
→ → → →
Domestic Violence
→
→
CVA →
→ →
45
→
→ →
COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS Birth – 4 years CATEGORIES Neoplastic
5 – 11 years
12 – 19 years
Wilms Leukaemia → Tumour Neuroblastoma Brain → tumours Smooth Bone → muscle tumour tumours Fibroadenoma Ovarian cysts Ovarian tumours
Fibroids
45 – 64 years
20-44 years
65 + years
→
→
→
→
→
→
→
→
→ → →
→ → →
→ →
Uterine cancers Breast Cancers → Ca Stomach Ca Lungs
→ →
→
→ →
→
→
→
Polycythemia BPH → Ca Prostrate → Ca –other → organs
46
COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS CATEGORIES
Degenerative
Birth – 4 years
5 – 11 years
12 – 19 years
20-44 years
45 – 64 years
Hernias Visual defects Hearing defects
→ →
→ →
→ →
→ →
→ →
→
→
→
→
→
Transient Ischaemia Peptic Ulcer Myocardial Infarction Renal calculi Varicosities Aneurysms Emphysema
→
→
→ →
→ →
→ → → → Urinary incontinence Osteoarthritis Parkinsons Disease
→ → → → →
65 + years
→ → Alzheimer’s Senility
47
COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS CATEGORIES Birth – 4 years Metabolic /Nutritional Endocrine
Proteincalorie malnutrition Failure to thrive Inborn error of metabolism Anaemias Vitamin deficiencies Malabsorption syndrome
5 – 11 years
12 – 19 years
→
→
→
→
→
→ →
→ →
→ →
→ →
→ →
→
→
→
→
→
→
→
→
Non-toxic goitre Gout → Thyrotoxicosis Myxoedemia →
→ → → → →
→ → → → →
→
→
→
20-44 years
45 – 64 years
65 + years
→
Obesity
Diabetes → Mellitus Hypertension →
48
COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS Birth – 4 years CATEGORIES Allergic/ Immunological
Eczema
5 – 11 years
12 – 19 years
20-44 years
45 – 64 years
→ Anaphylactic shock Serum sickness
→ →
→ →
→ →
65 + years
→ Nephritic syndrome Hay fever
SLE Rheumatoid arthritis Polyarthritis Infestations
Helminthiasis Scabies Schistomiasis Malaria Pedulosis Dengue
→ → → Filariasis → → →
→
→
→
→
→
→
→
→
Chikungunya
49
COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS Birth – 4 years CATEGORIES Psychosocial/ Psychiatric
5 – 11 years
12 – 19 years
20-44 years
45 – 64 years
65 + years
Separation anxiety Temper tantrums Dis-abilities
Pica Autism Brain damage Family conflicts Mental retardation
Epilepsy
Stress → Learning disabilities Conduct Disorder Sleep Disturbances Behaviour Disorder → Sleep Disturbances →
→ → →
→ → →
→ → →
→ → →
→
→
→
→
→
→
→
→
→
Delete please
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→ →
→
→
→
→
→
Enuresis encopresis Attention Deficit Disorder Attention Deficit Disorder with Hyperactivity → → Pseudocyesis →
Substance Abuse 50
Dependency substance abuse Neuroses Migraine Suicide psychoses
51
→
→
→
→ → → → →
→
→
→
→
COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES AGE GROUPS Birth – 4 years CATEGORIES Environmental
Health Infrastructure
5 – 11 years
12 – 19 years
20-44 years
45 – 64 years
65 + years
Ecological imbalances DiseasesVectors Housing issues Sewerage Solid waste /diseases Water borne diseases Food borne diseases Disasters
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→ →
→ →
→ →
→ →
→ →
→
→
→
→
→
→
→
→
→
→
→ →
→ →
→ →
→ →
→ →
Types of services Availability of care Quality of care Outcomes of care
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
→
52
Appendix 3
FIGURE II – SAMPLE TABLE OF SPECIFICATION: BLUE PRINT COMPONENTS Item No
Nursing Domain
Competency
Lifecycle
Basic Need
53
Nursing Process
Bloom’s Taxonomy
Health Problem
Appendix 4 PSYCHOMOTOR COMPETENCIES CORE LIST OF NURSING SKILLS FOR SCHOOL-BASED ASSESSMENT CLINICAL NURSING
YEAR 1-2
YEAR 3
Oxygen 1) 2)
Take, record and interpret and respond to vital signs. Administer oxygen by mask, nasal canula or tent.
3)
Administer steam inhalation
4)
Suction patient
5)
Instruct client on coughing and deep-breathing
→ → → → →
exercises 6)
7)
Collect specimens Sputum Nasal swab Throat swab Other body parts Perform cardiopulmonary resuscitation
8)
Prepare client for, and manage during and after:
→ → → → → → → → →
Thoracentesis Bone marrow aspiration Tracheostomony Underwater seal drainage Nebulization →
Nutrition 9)
Prepare and administer oral and parenteral fluids
→
10) Serve meals
→ →
Regular Special diets
11) Feed helpless clients
→ →
12) Feed infants and preschoolers 13) Administer artificial feeding:
→
Intravenous Nasogastric Gastrostomy
→ → 54
→
YEAR 4
→
hyperalimentation
14) Measure height, weight and circumferences 15) Measure and record intake and output.
→ →
CORE LIST OF NURSING SKILLS FOR SCHOOL-BASED ASSESSMENT CLINICAL NURSING
YEAR 1&2
YEAR 3
Elimination →
→
17) Prepare for urethral catherization (female).
→
→
18) Collect urine specimens for patient to include 24hour specimen
→
16) Prepare for urethral catherization (male).
→
19) Perform urinalysis
→
20) Give and remove bed pans/urinals 21) Care for and remove indwelling catheters
→
→
22) Managing urinary bladder drainage
Supra-pubic catheter Indwelling urethral catheter Condom drainage Other
→ → → → →
23) Irrigate urinary bladder →
24) Give cleansing enema
→
25) Insert rectal suppositories
→
26) Care for stoma 27) Observe neurological signs
→
→
28) Care for patients in splints, casts and tractions
→
→
→ → →
→
→
→
29) Perform range-of-motion exercises 30) Assist patient to move in and out of bed 31) Lift, turn and position patient 32) Perform last offices
55
YEAR 4
Sensory Stimulation →
33) Instill drops – eye, ear and nose
→ → →
34) Assess ocular and auditory senses 35) Cleanse eyelids
→
36) Collect conjunctival specimen 37) Apply eye-pads
→ →
CLINICAL NURSING 38) Irrigate eye
YEAR 1&2 →
→
→
→
→ → →
→ → →
39) Irrigate ear
YEAR 3
Safety and Security 40) Administer medications:
→
Oral Parenteral Hypodermic Intramuscular
→
41) Maintain Pharmaceutical supplies 42) Care of wound
→ →
Surgical dressing Removal of sutures and clips Removal of drains and packs Wound irrigation
→ →
43) Give bed bath
→
44) Give mouth care
→ →
45) Give skin and pressure area care 46) Apply bandages, splints, restraints, tourniquets, other 47) Use and maintain prostheses:
Wheelchair 56
→
YEAR 4
→ → → →
Walkers Canes Crutches Artificial limbs Other
→
48) Apply electric and electronic patient devices
→
49) Conduct a screening programme →
50) Make beds and use bed accessories
→
51) Arrange equipment/instruments for minor operations 52) Perform barrier nursing and infection control 53) Do case finding and contact tracing 54) Counsel patient and family 55) Prepare patient / client and equipment for delivery
57
→
→
→
→ → → →
→ → → →
CORE LIST OF NURSING SKILLS FOR SCHOOL-BASED ASSESSMENT CLINICAL NURSING
YEAR 1&2
56) Observe ante, intra-and post-partum patients. 57) Give sitz bath, vulval swab, episiotomy care
YEAR 3
YEAR 4
→ →
→ →
→ →
→ →
→ → →
→ → →
58) Prepare patient for:
Surgery Bone marrow aspiration Paracentesis abdominis Lumbar puncture Endoscopy
Sexuality 59) Prepare for examination of genital area (male and female)
→
→
→
→
→
Nursing Process 60) Utilize the nursing process in giving care:
Assessing – to include history taking and complete physical assessment
NURSING DIADNOSIS
Planning – to include written care plan
→
→
→
Implementing- to include report and Recording
→
→
→
Evaluating- to assess outcomes of care
→
→
→
→
→
→
→
→
→
→
→
FUNCTIONAL NURSING 61) Use interview techniques 62) Counsel and teach patient / client 63) Perform management skills:
Planning 58
Organizing Directing
→ →
→ →
Controlling
Directing
→ →
→ →
Apply:
Epidemiological approach
Research methodology
→ →
59
Appendix 5 CLINICAL SKILLS ASSESSMENT TOOL YEAR III – SURGICAL ASEPSIS
NAME:
LEVEL:
NEED: SAFETY AND SECURITY
DATE:
PROCEDURE: SIMPLE DRESSING AREAS ASSESSED ACCEPTABLE A. Preparation - Check doctor’s orders - Inform patient & explain procedure - Wash hands - ?Prepares the unit - Assemble necessary equipment B. Principles of Surgical Asepsis 1. Check expiry date - Set to be used - Cheatle forceps and other equipment/supplies - Solutions 2. Change cheatle solution as necessary at least ½ hour prior to procedure and place new label on container 3. Ensure room is clean and tidy 4. Close windows and doors(minimize spread of organisms) 5. Minimize traffic in and out of room 6. Gown must not touch 60
UNACCEPTABLE
trolley or sweep the floor 7. Prepare trolley in keeping with agency’s policy - Scrub hands thoroughly before procedure and when necessary during procedure - Prepare trolley in closed area - Don mask to cover mouth and nose - Open sterile pack without touching contents - Add only sterile articles and solution to sterile field - Ensure solution container does not touch sterile field - When pouring. Hold solution container to the edge of sterile field to prevent contamination - Do not turn back to sterile trolley - Do not reach over sterile field - Handles sterile articles with sterile forceps/gloves - Discard contaminated articles into suitable receptacles - Arrange fenestrated towel over surgical area where appropriate - Contents of trolley must remain sterile before and during procedure C - Document necessary information clearly.
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Appendix 6 CLINICAL SKILLS ASSESSMENT TOOL YEAR III – WARD MANAGEMENT
NAME: NEED:
LEVEL: Safety and Security
FINDINGS:
DATE:
ACCEPTABLE
UNACCEPTABLE
FINDINGS Activities to be performed in keeping with management functions. A. PLANNING
Setting goals and objectives Developing care plans (assessment- identification of problem) Requisitioning of supplies/equipment Setting priority- diet sheets, classification of patient and flow sheets etc. Developing work plan
B. ORGANISING
Allocating staff/providing coverage Delegating of duties Managing time Providing resources/supplies and equipment Prioritizing activities Conducting Pre Conferences/Staff Conferences/Meetings Drs. Rounds
C. CONTROLLING/DIRECTING/COORDINATING
Making decisions/problem solving Providing effective leadership Monitoring/supervising nursing care Supervising of students Teaching of juniors Referring of patients/clients Sending off requests/interpreted (interpreting doctor’s orders)
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D. EVALUATION Care plan revalidation Auditing nursing care Evaluating ward goals through post conferences Appraising Staff
63
Appendix 7 CLINICAL ASSESSMENT TOOL YEAR III – WARD MANAGEMENT ACTIVITY MANAGED CARE FOR EXAMINER’S USE ONLY a. Assessment -
Prepare forward round Receives/Take over Patient/Client Greet patient and relatives (if present) Conduct initial assessment (focus on problem) Collect data from relevant documents Interviews patient (s) and significant others Focus on problem Examine patient (s) with focus on problem Document data promptly (accuracy, relevance and adequacy)
b. Analysis of information obtained -
Identify problem (s) Actual Potential
c. Prioritize problems of patient d. Set goals/objectives of care State SMART objectives - Specific - Measurement - Achievable - Realistic/relevant - Time frame Document plan of care (care plan) - Diagnosis(es) - Relevant objectives of care - Intervention measures - Evaluation (in properties) relate to problem Implement care plan - Oxygen - Nutrition - Rest, activity and comfort - Safety and Security 64
-
Elimination Sexuality Psychosocial
ďƒ˜ Evaluate Care
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Appendix 8 LIST OF CARICOM MEMBER COUNTRIES
Antigua and Barbuda The Bahamas Barbados Belize Commonwealth of Dominica Grenada Guyana Jamaica Montserrat St. Christopher and Nevis St. Lucia St. Vincent and the Grenadines Suriname Trinidad and Tobago
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Appendix 9 LIST OF PARTICIPANTS CHIEF NURSING OFFICERS/PRINCIPAL NURSING OFFICERS Mrs. Elnora Warner
–
Chairman of the Regional Nursing Body Principal Nursing Officer Antigua and Barbuda
Dr. Wendy Sealey
–
Deputy Chairman of the Regional Nursing Body, Chief Nursing Officer Barbados
Ms. Augustina Elijio
–
Chief Nursing officer, Belize
Mrs. Caesarina L. Ferrol
–
Principal Nursing officer, Dominica
Ms. Nester Edwards
–
Chairman, Education Committee of the Regional Nursing Body; Chief Nursing Officer, Grenada
Mrs. Taramattie Barker
–
Chief Nursing Officer, Guyana
Mrs. Marva Lawson – Byfield
–
Chief Nursing Officer, Jamaica
Mrs. Henrietta Douglas–Christmas
–
Chief Nursing Officer St. Christopher and Nevis
Mrs. Marylene Paul
–
Chairman of the Practice Committee of the Regional Nursing Body; Chief Nursing Officer Saint Lucia
Ms. Peggy Da Silva
–
Senior Nursing Officer, Ministry of Health St. Vincent and the Grenadines
Ms. Carol De Baas
–
Chief Nursing Officer, Suriname
Mr. Oscar Noel Ocho
–
Chief Nursing Officer (ag.), Trinidad and Tobago
Ms. Laura Lynn Jackson
–
Assistant Chief Nursing Officer, Bermuda
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Ms. Hazel Brown
– Chief Nursing Officer, Cayman Islands
Ms. Jackurlyn Sutton
– Chief Nursing Officer, Turks and Caicos Islands
MEMBERS OF NURSING COUNCIS Ms. Laurellyn Williams
– Registrar, Nursing Council Antigua and Barbuda
Mrs. Heather Deane
– Chairman, Nursing Council of Barbados
Ms. Jean Jacob
– Chair, General Nursing Council, Dominica
Ms. Pricilla Hopkin
– Director of Nursing/Chief Nursing Officer (ag), Grenada
Mrs. Merle Rochester–Riley
– Registrar, General Nursing Council of Jamaica
Mrs. Pearline Cooper–Sharpe
– Chairman, General Nursing Council of Jamaica
Ms. Naomie Joseph-Foster
– Member, Nurses and Midwives Board, Ministry of Health, Montserrat
Ms. Shirley Kelly
– Dean, Health Science Division, CFBC/ Nursing Council, St. Kitts and Nevis
Ms. Maureen Stapleton
– Registrar, Midwives Council, St. Kitts and Nevis
Ms. Lucia Lee
– Chairperson, General Nursing Council of Saint Lucia
Mrs. Ann De Roche
– Registrar, General Nursing Council, St. Vincent and the Grenadines
Ms. Karin Pierre
– President, General Nursing Council Trinidad and Tobago
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ORGANIZATIONS/INSTITUTIONS Mrs. Antonette Patterson–Barkley
– President of the Caribbean Nurses Organization (CNO)
Dr. Steve Weaver
– Head, University of the West Indies (UWI) School of Nursing, Mona Campus, Jamaica.
Tabitha Malampati
– University of Guyana (UG), Guyana
Ms. Marcia Rollock
– President, Caribbean Midwives Association (CRMA)
OBSERVERS Ms. Debra Ann Henry
- Deputy Chief Nursing Officer. Guyana
Ms. Emily Cumberbatch
- Public Health Nurse Tutor, Guyana
Ms. Veronica Rodrigues-Douglas
- Senior Health Visitor, Guyana
Ms. Wilton Benn
- Maternal and Child Health Officer, Guyana
Ms. Audrey Corry
- Director/Nursing Services, Georgetown Public Hospital (GPH), Guyana
Ms. Zaheeda Hack
- General Nursing Council, Guyana
Ms. Pearl Munroe
- Nursing Educator, General Nursing Council, Guyana
MsPatrucua Gravesande
- Director, St. Joseph Mercy Hospital, Guyana
MINISTRY OF HEALTH - GUYANA Mr. Shamdeo Persaud
- Chief Medical Officer, Ministry of Health, Guyana
CARICOM SECRETARIAT Dr. Rudolph Cummings
– Programme Manager, Health Sector Development
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Appendix 10
REFERENCES 1.
Caricom Secretariat (1992). Blueprint – Regional Examination for Nurse Registration, Guyana, Georgetown.
2.
Caricom Community Secretariat (1992) – Administration Manual. Regional Examination for Nurse Registration (RENR) CARICOM Countries
3.
Caricom Community Secretariat (2007) – Proposals for a Revised Curriculum and New Management Strategy for the Regional Examination for Nurse Registration and Strategy and Plan of Action for Implementation.
4.
Lynn, Christine E, (2008), College of Nursing, www.fau.edu.
5.
Nova Southeastern University, Nursing www.nova.edu/
6.
Parris, Janey (2006) Report on the Proposal for the Management of the Regional Examination for Nurse Registration in CARICOM Countries, Georgetown, Guyana.
7.
Parris, Janey (2006) Report on the Revised Curriculum for the Regional Examination for Nurse Registration CARICOM Countries.
8.
Regional General Nursing Councils (1993) – Guidelines for Regional Examination for Nurse Registration.
9.
Trinitas School of Nursing – (2007) catalogue – www.ucc.edu./nr/.....
10.
World Health Organisation (WHO) (2009) Global Standards for the Initial education of professional nurses and midwives.
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