Indian Nursing Council (Post Basic Diploma in Neonatal Specialty Nursing - Residency Program), Regulations, 2020
Published vide Notification No. F.No. 11-1/2019-INC, dated 22.02.2021
Last Updated 26th February, 2021 [act3824]
F.No. 11-1/2019-INC. - 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 Indian Nursing Council (Post Basic Diploma in Neonatal Specialty Nursing - Residency Program), Regulations, 2020. ii. These Regulations 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 Indian Nursing Council and software developed in association with National Informatics Centre (NIC), Government of India, and hosted by NIC for the purpose of maintenance and operation of the Indian Nurses Register. It has standardised forms for collection of the data of Registered Nurse and Registered Midwife (RN&RM)/Registered Auxiliary Nurse Midwife (RANM)/Registered Lady Health Visitor (RLHV) upon Aadhar based biometric authentication;
vi. 'NUID' is the Nurses Unique Identification Number given to the registrants in the NRTS system;
vii. 'General Nursing and Midwifery (GNM)' means Diploma in General Nursing and Midwifery qualification recognized by the Council under Section 10 of the Act and included in Part-I of the Schedule of the Act.
Post Basic Diploma In Neonatal Specialty Nursing - Residency Program 2020
I. Introduction
The National Health Policy document (NHP, 2017) emphasizes the need to expand tertiary care services, prepare specialist nurses and standardization of clinical training for nurses. Responding to this, the Council planned to redesign the existing specialty nursing programs making it as a one-year post basic diploma residency programs utilizing competency-based training approach. Neonatal nursing is a new specialty prepared by the Council using revised guidelines that aim to prepare specialist nurses who can provide competent care to neonates with various medical and surgical conditions in which diagnostic, treatment, and care needs are complex and intensive. India faces the biggest newborn health challenge in the world. The country is on the threshold of a neonatal survival revolution with the concerted efforts of the Government of India and professional bodies aimed at bringing about a reduction in Infant Mortality Rate (IMR) and Neonate Mortality Rate (NMR). The specialized newborn care facilities have grown rapidly during the last two decades. A number of level II special care units and Neonatal Intensive Care Units (NICU's) have been established in teaching as well as corporate hospitals. The above revolution in newborn care demands adequate number of nurses specially trained in neonatal nursing who will function as neonatal specialist nurses. Therefore, it is essential for the health care system to meet such needs effectively. In this context, it is highly significant to strengthen or establish education and training programs to prepare super-specialty nurses for tertiary care institutions, who can provide safe, competent and compassionate care to neonates.II. Philosophy
The Council believes that registered nurses need to be further trained as specialist nurses to function in various emerging speciality areas of practice and the training should be competency based. One such area that demands specialist nurses is Neonatal Nursing. Expanding roles of nurses and advances in technology necessitates additional training to prepare them for effective participation in neonatal care within their scope of practice.III. Curricular Framework
The Post Basic Diploma in Neonatal Specialty Nursing education is a one-year residency program and its curriculum is conceptualized encompassing foundational short courses and major specialty courses for specialty nursing practice. The foundations to Neonatal Nursing practice such as Professionalism, Communication & parental education, Clinical leadership & resource management, and Evidence based & applied research are short courses that aim to provide the students with the knowledge, attitude and competencies essential to function as accountable, committed, safe and competent specialist nurses. The major specialty courses are organized under Neonatal Specialty Nursing I and Neonatal Specialty Nursing II. Specialty Nursing I includes Applied Anatomy and Physiology, Embryology, Pharmacology, Genetics, Community Health, Obstetrics, Neonatal Advance Life Support. Specialty Nursing II includes feeding of normal and low birth weight babies, policies and procedures for prevention of infections in NICU, nursing management of common medical and surgical problems in neonates and role of neonatal nurses in various investigations and procedures carried out on neonates. The curricular framework for the Neonatal Specialty Nursing - Residency Program is illustrated in the following figure-1.
IV. Aim/purpose & Competencies
Aim/purpose
The program is designed to prepare nurses with specialized skills, knowledge and attitude in providing quality care to neonates with neonatal disorders. It further aims to prepare technically qualified and trained specialist nurses who will function effectively and optimally at Neonatal care units of Tertiary/Quaternary hospitals providing high standards of care.Competencies
On completion of the program, the neonatal specialist nurse will be able to:1. Demonstrate professional accountability for the delivery of nursing care as per the Council standards that is consistent with moral, altruistic, legal, ethical, regulatory and humanistic principles in neonatal nursing practice.
2. Communicate effectively with parents, families and professional colleagues fostering mutual respect and shared decision making to enhance health outcomes.
3. Educate and counsel parents and families to participate effectively in treatment and care and enhance their coping abilities through crisis and bereavement.
4. Demonstrate understanding of clinical leadership and resource management strategies and use them in neonatal care and settings promoting collaborative and effective teamwork.
5. Identify, evaluate and use the best current evidence in neonatal care and treatment coupled with clinical expertise and consideration of patient's preferences, experience and values to make practical decisions in neonatal nursing practice.
6. Participate in research studies that contribute to evidence-based neonatal nursing care interventions with basic understanding of research process.
7. Apply basic sciences in the assessment, diagnosis and treatment of the physiological, physical, psychological, social and spiritual problems of neonates with neonatal disorders and their families.
8. Apply nursing process in caring for neonates with neonatal disorders.
9. Describe the principles of fluid, electrolyte, nutrition and elimination management, developmental supportive care, pain management, infant temperature management in treatment of neonates with neonatal disorders.
10. Demonstrate specialized practice competencies/skills relevant in providing care to neonates under different treatment regimes.
11. Demonstrate skill in managing neonates undergoing various surgeries.
12. Identify treatment related adverse effects and emergencies and manage them effectively.
13. Understand the method of drug procurement, storage, administering and maintenance of neonatal equipment, exchange transfusion, immune therapy and demonstrate sound practice.
14. Understand the maintenance of special equipment such as radiant warmer, pulse oximeter, phototherapy, oxygen concentrator, weighing scale, infusion pump, resuscitation bag, glucometer, suction machine, etc.
15. Demonstrate empathy and humane approach towards neonates and their families.
16. Conduct clinical audit and participate in quality assurance activities in neonatal units/centres.
17. Provide palliative care to neonates with emphasis to end of life care and bereavement management promoting comfort and dignity respecting individual cultural and spiritual needs and differences.
V. Program Description & Scope of Practice
The Post Basic Diploma in Neonatal Specialty Nursing program is a one-year residency program with main focus on competency-based training. Theory includes foundational courses and specialty courses besides practicum. The theory component comprises 10% and practicum 90% (Lab and Clinical). On completion of the program and certification, and registration as additional qualification with respective SNRC, the neonatal specialist nurses should be employed only in the specialty hospital/department/unit as neonatal specialist nurses. They will be able to practice as per the competencies trained during the program particularly the specialized procedural competencies/clinical skills as per the logbook of the Council syllabus. The specialist nurses can be privileged to practice those specialized procedural competencies by the respective institution as per institution protocols. Specialist nurse cadre/positions should be created at government/public/private sectors. The diploma will be awarded by respective Examination Board/SNRC/University approved by the Council.VI. Minimum Requirements/guidelines For Starting The Post Basic Diploma In Neonatal Specialty Nursing - Residency Program
1. The program may be offered at
a. College of Nursing offering degree programs in nursing attached to parent specialty hospital/tertiary hospital having a minimum of 200 beds with diagnostic, therapeutic and state of the art neonatal units with optimum neonatal supportive care and specialized nursing care facilities.
Or
Hospitals offering DNB/Fellowship programs in neonatology having minimum of 200 beds with diagnostic, therapeutic and state of the art neonatal units with optimum neonatal supportive care and specialized nursing care facilities.
b. The above eligible institution shall get recognition from the concerned SNRC for Post Basic Diploma in Neonatal Specialty Nursing for the particular academic year, which is a mandatory requirement.
c. The Council shall after receipt of the above documents/proposal would then conduct statutory inspection of the recognized training nursing institution under Section 13 of the Act in order to assess the suitability with regard to availability of teaching faculty, clinical and infrastructural facilities in conformity with Regulations framed under the provisions of the Act.
2. Nursing Teaching Faculty
a. Full time teaching faculty in the ratio of 1 : 10.
b. Minimum number of faculty should be two.
c. Qualification and Number:
i. M.Sc. Nursing with Child Health Nursing Speciality - 1
ii. Post Basic Diploma in respective nursing specialty with Basic B.Sc. (Nursing)/P.B.B.Sc. (Nursing) - 1
d. Experience: Minimum three years of clinical experience in neonatal specialty nursing
e. Guest Faculty: Multi-disciplinary in related specialities
f. Preceptors:
• Nursing Preceptor: Full time qualified GNM with 6 years of experience in specialty care nursing (Neonatal nursing) or B.Sc. (Nursing) with 2 years' experience in specialty nursing or M.Sc. (Nursing) with one year neonatal specialty nursing experience working in the neonatal specialty care unit.
• Medical Preceptor: Specialist (Neonatologist) doctor with PG qualification (with 3 years post PG experience/faculty level/consultant level preferable)
• Preceptor Student Ratio: Nursing 1 : 10, Medical 1 : 10 (Every student must have a medical and nursing preceptor)
3. Budget
There should be budgetary provision for staff salary, honorariums for guest faculty, and part time teachers, clerical assistance, library and contingency expenditure for the program in the overall budget of the institution.4. Physical and Learning Resources at Hospital/College
a. One classroom/conference room at the clinical area.
b. Skill lab for simulated learning at hospital/college. Skill Lab requirements are listed in Appendix-1.
c. Library and computer facilities with access to online journals.
i. College library having current books, journals and periodicals related to respective nursing specialty, Nursing Administration, Nursing Education, Nursing Research and Statistics.
Or
Permission to use medical college/hospital library having current books, journals and periodicals related to respective nursing specialty, Nursing Administration, Nursing Education, Nursing Research and Statistics.ii. Computer with internet facility.
d. E-Learning facilities.
e. Teaching Aids - Facilities for use of:
i. Overhead Projectors,
ii. Video viewing facility,
iii. LCD Projector,
iv. CDs, DVDs and DVD players.
v. Appropriate equipment, manikins and simulators for skill learning.
f. Office facilities:
i. Services of typist, peon, Safai Karamchari
ii. Facilities for office, equipment and supplies such as
• Stationery,
• Computer with printer,
• Xerox machine,
• Telephone and Fax.
5. Clinical Facilities
a. Parent specialty hospital/tertiary hospital having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art neonatal units with optimum neonatal supportive care and specialized nursing care facilities.
b. Regional centres/Neonatal specialty hospitals having minimum of 200 beds with advanced diagnostic, therapeutic and state of the art neonatal units with optimum neonatal supportive care and specialized nursing care facilities.
c. Hospital must have a minimum of 20 specialty beds (Level 2 & 3) with advanced diagnostic, treatment and care facilities.
d. Nurse staffing of units as per the Council recommended norms.
e. Student patient ratio: 1 : 2-3
6. Admission Terms and Conditions/Entry Requirements
The student seeking admission to this program should:
a. Be a registered nurse (RN&RM) or equivalent with any SNRC having NUID number.
b. Possess a minimum of one year clinical experience as a staff nurse preferably in the neonatal unit prior to enrolment.
c. Be physically fit.
d. Selection must be based on the merit obtained in entrance examination and interview held by the competent authority.
e. Nurses from other countries must obtain an equivalence certificate from the Council before admission.
7. Number of Seats
For hospital having 200 beds and 10-20 NICU beds, number of seats = 5-10,
For hospital having 500 beds or more and with 20 or more NICU beds, the number of seats = 10-20.
8. Number of Candidates
1 candidate for 2-3 specialty beds.
9. Salary
a. In-service candidates will get regular salary.
b. Stipend/Salary for the other candidates will be given as per the salary structure of the hospital where the program is conducted.
Vii. Examination Regulations And Certification Examination Regulations
Examining and Diploma Awarding Authority: Respective Examination Board/SNRC/University approved by the Council.
1. Eligibility for Appearing in the Examination
a. Attendance: Theory & Practical: 80%. However, 100% Clinical attendance have to be completed prior to certification.
b. Candidate who successfully completes the necessary requirements such as Log Book and clinical requirements is eligible and can appear for final examination.
2. Practical Examination
a. OSCE: Objective Structured Clinical Examination (OSCE) type of examination (for Basic Competency Assessment) will be conducted alongside viva (oral examination) both in the internal and final examination. (Detailed guidelines are given in guidebook.)
b. Observed Practical/Clinical: Final internal and external examination will also include assessment of actual clinical performance in real settings including viva and mini clinical evaluation exercise for 3-4 hours (Nursing process application and direct observation of procedural competencies). Minimum period of assessment in the clinical area is 5-6 hours. (Evaluation guidelines are given in guidebook.)
c. Maximum number of students per day = 10 students.
d. Practical Examination should be held in clinical area only.
e. The team of practical examiners will include one internal examiner {(M.Sc. faculty with two years of experience in teaching the respective specialty program/M.Sc. faculty (Child Health Nursing) with 5 years of Post PG experience}, one external examiner (nursing faculty with the same qualification and experience stated as above) and one medical internal examiner who should be preceptor for specialty program.
f. The practical examiner and the theory examiner should be the same nursing faculty.
3. Standard of Passing
a. In order to pass, a candidate should obtain at least 60% marks in aggregate of internal assessment and external examination both together, in each of the theory and practical papers. Less than 60% is considered fail.
b. Students will be given opportunity of maximum of 3 attempts for passing.
c. If the student fails in either theory or practical, he/she needs to appear for the exam failed either theory or practical only.
4. Certification
a. TITLE: Post Basic Diploma in Neonatal Specialty Nursing
b. A diploma is awarded by Examination Board/SNRC/University approved by the Council, upon successful completion of the prescribed study program, which will state that
i. Candidate has completed all the courses of study under the Post Basic Diploma in Neonatal Specialty Nursing - Residency Program
ii. Candidate has completed 80% theory and 100% clinical requirements
iii. Candidate has passed the prescribed examination.
VIII. Scheme of Examination
|
Courses |
Int. Ass. Marks |
Ext. Ass. Marks |
Total Marks |
Exam Hours (External) |
|
Theory (Experiential/Residential Learning) |
25 (10+15) |
75 (35+40) |
100 |
3 |
|
Neonatal Specialty Nursing (Part I and Part II) (Part I: Neonatal Specialty Nursing I including Foundations, Part II: Neonatal Specialty Nursing II) |
||||
|
Practicum: Neonatal Specialty Nursing |
75 (25+50) (OSCE & Observed Practical) |
150 (50+100) (OSCE & Observed Practical) |
225 |
Minimum 5-6 hours in the clinical area |
|
• OSCE including Viva • Observed Practical/Clinical (Direct observation of actual performance at real settings) including viva - mini clinical evaluation exercise for 3-4 hours (Nursing process application and direct observation of procedural competencies) |
||||
|
Grand Total |
100 |
225 |
325 |
|
IX. Program Organization/structure
1. Courses of Instruction
2. Implementation of Curriculum
3. Clinical Practice (Residency Posting)
4. Teaching Methods
5. Methods of Assessment
6. Clinical Log Book and Procedures Book
1. Courses of Instruction - Delivered through mastery of learning (Skill Lab Practice) and experiential learning (including Clinical Practice) approaches|
S.No. |
Courses |
Theory (Hours) |
Lab/Skill Lab (Hours) |
Clinical (Hours) |
|
I
II |
Foundations to Neonatal Specialty Nursing Practice 1. Professionalism 2. Communication, parent education and counselling in specialty nursing 3. Clinical leadership and resource management in the specialty care setting 4. Evidence based and applied research in specialty nursing Neonatal Specialty Nursing Courses Neonatal Specialty Nursing I 1. Context/Introduction to specialty nursing 2. Basic sciences applied to specialty care: diagnosis and treatment of clinical conditions (Anatomy & Physiology, Microbiology, Pharmacology & Pathophysiology) Neonatal Specialty Nursing II 3. Nursing management of clinical conditions including assessment, diagnosis, treatment and specialized interventions 4. Patient safety and quality 5. Specialty/Illness specific considerations (Developmental Supportive care/palliative care/ rehabilitation, Impact of illness on parents, family and community) |
40
50
110 |
10
30 |
1730 |
|
TOTAL = 1970 hours |
200 (5 weeks) |
40 (1 week) |
1730 ( 38 weeks) |
|
|
S.No. |
Clinical Area |
Week |
Remarks |
|
1 |
Neonatal Intensive Care Unit |
12 |
Postings in Own Neonatal specialty hospital/ Neonatal care units |
|
2 |
Post-natal Ward |
04 |
|
|
3 |
KMC Ward/Human Milk Bank |
04 |
|
|
4. |
Labour Room (Newborn Care Corner) |
04 |
|
|
5. |
OPD |
04 |
|
|
6. |
Neonatal Surgical Ward |
10 |
|
|
7. |
Reputed Neonatal Centers |
04 |
Attachment/visits |
|
|
TOTAL |
42 |
|
4. Teaching Methods
Theoretical, Skill Lab and Clinical teaching can be done in the following methods and integrated during clinical posting:
• Case/Clinical presentation and case study report
• Drug study and presentation
• Bedside clinic/Nursing rounds/Interdisciplinary rounds
• Journal clubs/Clinical seminar
• Faculty lecture and Discussion in the clinical area
• Demonstration and skill training in skill lab and at bedside
• Directed reading/Self-study
• Role play
• Symposium/Group presentation
• Group research project - Research/QI
• Clinical assignments
• Parental involvement and empowerment exercise (engaging parents in care decisions of neonates to improve health outcomes using information technology) for example, discharge planning, follow up and home-based care.
• Educational visits to regional Level II & III NICU, KMC unit and Human milk banks.
5. Method of Assessment
• Written test (Case or scenario based)
• Practical examination: OSCE and Observed Practical (Direct observation of actual clinical performance at real settings)
• Written assignments
• Project
• Case studies/care plans/clinical presentation/drug study
• Clinical performance evaluation
• Completion of clinical procedural competencies and clinical requirements For assessment guidelines refer Appendix-2
6. Clinical Log Book/Procedures Book
At the end of each clinical posting, Clinical Log Book (Specific Procedural Competencies/Clinical Nursing Skills) (Appendix 3), Clinical Requirements (Appendix 4) and Clinical Experience Details (Appendix 5) have to be signed by the concerned clinical faculty/preceptor.X. Course Syllabus
Foundations To Neonatal Specialty Nursing Practice:
Professionalism, Communication, Parental Education & Counseling, Clinical Leadership & Resource Management And Evidence Based And Applied Research In Neonatal Specialty Nursing Practice Total Theory: 40 Hours Course description: This course is designed to develop an understanding of professionalism, communication, parental education and counselling; clinical leadership and resource management and evidence based and applied research in Neonatal nursing practice.Course Content
|
Unit |
Time (hours) |
Learning Outcomes |
Content |
Teaching/ Learning activities |
Assessment methods |
|
I |
6 |
Demonstrate understanding of professionalism and exhibit professionalism in the practice of neonatal nursing.
Describe medicolegal aspects of neonatal nursing |
Professionalism • Meaning and elements: Accountability, knowledgeable, visibility and ethical in neonatal specialty nursing practice • Professional values and professional behaviour • INC Code of ethics, code of professional conduct and practice standards • Ethical issues related to neonatal nursing • Expanding Role of Nurse - Neonatal Specialty Nurse/Nurse Practitioner • Professional organizations • Continuing nursing education Medico-Legal Issues • Legislations and regulations related to neonatal nursing • Consumer protection act • Negligence and malpractice • Medico-legal aspects • Records and reports • Legal responsibilities of neonatal specialist nurses |
• Discussion • Lecture cum Discussion |
• Write about code of ethics related to neonatal nursing • Maintain record of patients |
|
II |
12 |
Communicate effectively with parents of neonates, families and professional colleagues fostering mutual respect and shared decision making to enhance health outcomes
Educate and counsel parents and families to participate effectively in treatment and care |
Communication • Channels and Techniques of communication • Breaking bad news to parents of neonates with medical & surgical disorders of poor prognosis • Culturally sensitive communication • Development of nursing care plans and records • Information technology tools in support of communication • Team communication Parental and Family Education • Principles of teaching and learning • Principles of health education • Assessment of information and education needs of parents and family and education materials Counseling • Counselling techniques • Parent and family counselling during breaking bad news, intensive treatment, crisis intervention and end-of-life stage |
Module • Lecture • Breaking bad news - Role play • Peer teaching • Counseling sessions |
• Digital records
• Conduct a group health education program for the parents of neonates with various disorders • Prepare parental education materials on relevant topic for mass awareness |
|
II |
12 |
Demonstrate understanding of clinical leadership and management strategies and use them in neonatal care and settings promoting collaborative and effective teamwork Prepare the Neonatal Care Units or Special Newborn Care Units (SNCU) Conduct clinical audit and participate in quality assurance activities in Neonatal units/ centres |
Clinical Leadership and Resource Management • Leadership and Management • Elements of management of Neonatal nursing care - planning, organizing, staffing, reporting, recording and budgeting • Clinical leadership and its challenges • Delegation • Managing human resources in Neonatal units • Material management • Designing of an ideal Neonatal care unit Level II and Level III, KMC ward and Human milk banks • Emotional intelligence and selfmanagement skills • Working as interdisciplinary team member • Participation in making policies relevant to care of neonates • Organization of neonatal care units with various Neonatal disorders Quality Assurance Program in Neonatal Units/Centres • Nursing audit • Nursing standards Quality assurance |
• Lecture • Demo - Preparation of Neonatal Care unit or SNCUs. • Visit SNCU of any specialized Children Hospital • Modules • Accreditation and Practice Standards |
• Plan a duty roster for the junior nursing officers/Staff nurses working in the neonatology department/ unit • Plan an ideal Neonatal care unit Level II and Level III, KMC ward and Human milk banks • Assignment on designing of Special Neonatal Care unit/s • Develop SOPs for Neonatal wards and Special Neonatal care units |
|
IV |
10 |
Describe research process and perform basic statistical tests Conduct research project using principles and steps of research Apply evidence based/best practices in professional practice |
Evidence based and application of research • Introduction to nursing research and research process • Data presentation, basic statistical tests and its application • Research priorities in Neonatal nursing • Formulation of problem/question that are relevant to Neonatal nursing practice • Review of literature to identify evidence based/best practices in Neonatal nursing practice • Implementation of evidence-based interventions in daily professional practice • Ethics in research |
• Lecture Module: Writing of scientific paper |
• Preparation of statistical data of Neonatal Department for last five years
• Conduct literature review on neonatal nursing interventions
• Group research project |
Context/introduction To Neonatal Nursing & Basic Sciences Applied To Neonatal Nursing Practice
(Psychology & Sociology, Anatomy & Physiology, Genetics, Community Health, Pharmacology, Obstetrics, Embryology, Neonatal Advance Life Support)
Theory: 50 hours and Lab: 10 hours Course description: This course is designed to help students to develop understanding and in-depth knowledge regarding the context of neonatal care provision and application of basic sciences in the diagnosis and treatment of neonates suffering from various medical and surgical disorders.Course Content
|
Unit |
Time (Hours) |
Learning Outcomes |
Content |
Teaching/Learning Activities |
Assessment Methods |
|
I |
2 (T) |
Describe epidemiology of common Neonatal disorders, risk identification and reduction strategies |
• Epidemiology of neonatal disorders - Prevalence and statistics • Risk factors and identification • Risk reduction strategies |
• Lecture cum Discussion |
• Presentation of Statistics |
|
II |
8 (T) 2 (L) |
Explain general concepts and principles of Neonatal nursing • Definition, concepts and principles of neonatal nursing Role of Neonatal specialist nurses |
Introduction to Neonatal Nursing • Visit to Level II and Level III Neonatal Care Units • Attributes of a neonatal nurse • Levels of neonatal care and role of nurse • Criteria for admission to NICU • Nursing process • Role of Neonatal specialist nurses • Scope of Neonatal nursing practice |
• Lecture cum Discussion |
Asesment of skills with check list |
|
III |
5 (T) |
Explain Psychosocial aspects in Neonatal Nursing care |
Psychology • Individual differences • Learning, motivation, attention & perception • Emotions • Human behavior & needs in crisis • Stress & coping in crisis situations • Leadership • Communication and IPR • Attitude and humanizing care • Guidance & Counseling Sociology • Social organization & community resources • Leadership roles in community • Family and family relationship • Socio-cultural influences on child rearing |
• Lecture cum Discussion • Counseling - Review steps |
• Conduct counselling session |
|
IV |
4 (T) 2 (L) |
Explain medical Surgical asepsis and infection control in Neonatal setup |
Infection Control in Neonatal Setting • Immunity, Infection • Principles of asepsis, sterilization & disinfection • Diagnostic test and related nurse's responsibility • Standard safety measures • Biomedical waste management • Barrier Nursing & infection control practices |
• Lecture • Demonstration |
• Prepare SOP for Infection control in Neonatal unit • Written assignment: Infection control practices in Neonatal unit |
|
V |
8 (T) 2 (L) |
Describe the basic anatomy and physiology of various systems |
Review of Applied Anatomy and Physiology • Neurological system • Respiratory system • Cardiovascular system • Gastro intestinal system • Endocrine system • Musculoskeletal system • Genitourinary system • Reproductive system • Sensory organs |
• Lecture • Self-study • Demonstration at Laboratory |
• Quiz • Short answer |
|
VI |
6 (T) |
Understand cellular basis of Neonatology.
Explain genetic basis of Neonatology |
Genetic Basis of Neonatology • Lecture • Development of fetus from conception to birth • Fetal circulation • Meaning of genetics and heredity • Mendelian laws of inheritance • Genetic disorders 1. Chromosomal errors 2. Inborn errors of metabolism 3. Multifactorial disorders (sickle cell anemia, thalassemia, hemophilia) • Genetic counselling & Nurses' role in genetic counselling |
• Prepare a model of fetal circulation |
• Conduct counselling session |
|
VII 2 |
3(T) (L) |
Understand various health services and programs for neonates • Demography and family welfare - Definition, meaning, population trends - global and Indian |
Community Health Review • Maternal and child health services and programs - Organization of services - CSSM/RCH - Family welfare program • Health Education: concepts, principles, approaches and methods |
• Lecture • Visit to a District Hospital • Demonstration |
• Visit report • Prepare, plan and give health education to the parents and families of neonates |
|
VIII |
6 (T) |
Explain pharmacotherapy for different neonatal medical and surgical disorders |
Applied Pharmacology • Analgesics/Anti-inflammatory agents • Antibiotics, antiseptics • Drug reaction & toxicity • Drugs used in neonatal resuscitation • Blood and blood components • Principles of drug administration • Role of nurses and care of drugs |
• Lecture cum Discussion • Drug presentation |
• Drug study |
|
IX |
8 (T) 2 (L) |
Explain Feto-placental physiology. Understanding perinatology and care of normal newborn and high risk newborn in labour room |
Obstetrics Review • Pregnancy - Normal & High risk - Obstetrical disorders • Labor - Normal & Abnormal - Risk factors for neonates in antenatal and intra-natal period • Normal newborn - immediate care in labor ward • High risk neonate - IUGR, post maturity, babies of high risk mothers • Drugs used in obstetrics and their implications for the fetus/neonate |
• Lecture cum Discussion • Case discussion/ presentation • Supervised Clinical practice |
• Case study evaluation • Assessment of skills with check list • Drug Study |
Neonatal Specialty Nursing - II
Nursing Management Of Clinical Conditions Including Assessment, Diagnosis, Treatment & Specialized Interventions, Patient Safety & Quality And Specialty/illness Specific Considerations(Supportive Care/palliative Care/rehabilitation)
Theory: 110 hours and Lab: 30 hours Course description: This course is designed to help students to develop knowledge and competencies required for assessment, diagnosis, treatment, nursing management, and supportive/palliative care to patients with various Neonatal disorders.Course Content
|
Unit |
Time (Hours) |
Learning Outcomes |
Content |
Teaching/Learning Activities |
Assessment Methods |
|
I |
14 (T) 6 (L) |
Explain and demonstrate skill in assessment of neonates • Definitions & terminology Understanding normal adaptation and essential care of neonates |
Normal Newborn • Normal mother-baby relationship • Examination and Assessment of newborn • Recognition of danger signs in a newborn • Common minor neonatal disorders • Care of normal newborns • Immediate care • Routine care - Transition care • Daily care - Home care • Physiological adaptation of the neonate • Thermoregulation & prevention of hypothermia • Kangaroo Mother Care (KMC) |
• Lecture cum discussion • Demonstration on immediate care of newborn • Demonstrate the correct positioning and Care during KMC |
• Perform assessment of neonates in NICU and Neonatal wards • Write assessment report • Assessment of skills with the help of checklist |
|
II |
16 (T) 6 (L) |
Understanding various methods of feeding and demonstrating correct methods of feeding the neonates |
Methods of feeding Neonates • Physiology of breast and milk secretion • Principles of feeding & nutrition • Feeding of normal babies • Breast feeding & maintenance of lactation • Managing breast feeding problems • Feeding of LBW babies • Artificial feeding - Enteral, parenteral, Katori spoon, Gavage feeding • Total parenteral Nutrition (TPN) • Fluid & electrolyte balance & Fluid & electrolyte therapy |
• FBNC module (oral drills, videos, self-evaluation exercises) • Demonstration |
• Assessment of skills with the help of Checklist • Return demonstration on patients |
|
III |
14 (T) 4 (L) |
Develop skills in caring for low birth weight babies |
Caring for Low Birth Weight Baby • Types of LBW • Etiology • Identification of preterm & small for date babies • Problems of preterm & small for date babies • Management: Principles, thermoregulation, feeding, monitoring, transportation, management of specific illnesses |
• Pre-term care package • Write recent evidences in treating low birth weight newborns |
• Self-assessment |
|
IV |
24 (T) 3 (L) |
Describe etiology, pathophysiology, clinical manifestations, diagnosis and management of various medical disorders of neonates • Neonatal monitoring & observations |
Sick Neonate • Danger signs in newborns • Respiratory problems: Asphyxia neonatorum, apnea, Respiratory Distress Syndrome (RDS), meconium aspiration syndrome, respiratory infections • Neonatal sepsis • Neonatal jaundice • Convulsions & neurological disorders • Metabolic disorders • Necrotizing Entrocolitis (NEC) • HIV: transmission & Anti- Retroviral (ARV) Therapy • Emergency treatment of neonatal problems |
• Lecture cum discussion • Bed-side teaching • Discussion of case scenarios • Group presentations |
• Nursing clinic/rounds • Case presentation • Case discussion |
|
V |
22 (T) 3 (L) |
Describe etiology, pathophysiology, clinical manifestations, diagnosis and management of various surgical disorders of neonates • Birth trauma |
Management of various surgical disorders of neonates • Congenital malformations: Identification & management • Pre & Post-operative nursing care of a neonate with various surgical procedures: - Cleft lip & palate - Esophageal atresia and Tracheo-esophageal fistula - Congenital hypertrophic pyloric stenosis - Hirschsprungs' disease - Imperforated anus - Recto vaginal fistula (RVF) - Spina bifida (Meningomyelocele) - Hydrocephalus - Exstrophy of bladder - Congenital heart disease |
• Lecture cum discussion • Seminar |
• Write a case study • Develop nursing standards on management of neonates undergoing surgery • Conduct Health Education session for the parents of neonates with congenital malformations |
|
VI |
3 (T) 2 (L) |
Perform neonatal Resuscitation • Routine care |
Neonatal advance life support • Initial steps • Bag & mask ventilation • Chest compression • Endotracheal intubation • Drugs |
• Workshop on Neonatal resuscitation • NRP module • Demonstration & Practice Session |
$$$HINDI MATTER |
|
VII |
14 (T) 6 (L) |
Understand and demonstrate the skills in handling various equipment and conducting neonatal procedures • Neonatal procedures |
Neonatal procedures and handling special equipment • Principles of drug therapy, administration of drugs, commonly used drugs • Principles of temperature maintenance & its clinical disorders • Collection of specimens • Assisting with procedures & therapies • Use & maintenance of equipment • Neonatal records • Neonatal monitoring • Admission & transfer of sick neonates |
• Demonstration • Skilled videos |
• Return demonstration • Complete procedural requirements • Conducting unit audit |
|
VIII |
3 (T) |
Describe the impact of birth of a sick/ abnormal baby in the family |
Impact of birth of a sick/ abnormal baby on the family • Reaction of parents to the admission of their baby to NICU • Grief process • Causes, effects & management of stress • The personal & social problems of the family |
• Discussion and demonstration |
• Critical thinking and decision making |
1. Assess gestational age as well as physical and behavioral status of neonates
2. Monitor and interpret vital signs
3. Measure weight, height as well as head and chest circumferences
4. Provide immediate and daily care for neonates
5. Apply the nursing process in caring for normal and sick neonates
6. Assists in administration of medications via different routes
7. Follow the universal infection control precautions
8. Encourage mothers to breast feed whenever possible
9. Maintain optimal nutrition for neonates either enteral or parenteral
10. Encourage and facilitate parent child bonding
11. Assess and manage neonatal pain
12. Record and report any detected abnormality
13. Prepare parents for discharge and home care
14. Provide health education concerning child care & follow up
15. Documents findings, nursing care & abnormalities
Clinical Postings
|
Areas |
Duration (week) |
Clinical Learning Outcomes |
Skills/Procedural Competencies |
Assignments |
Assessment Methods |
|
Neonatal Intensive Care Unit |
12 weeks |
Provide nursing care for patients suffering from Neonatal disorders |
Assessment of Neonates • Identification & assessment of risk factors • Gestation age assessment • Detection of life threatening congenital abnormalities • Admission & discharge of neonates • Monitoring of Neonates - clinically & with monitors - CRT (Capillary Refill Time) - assessment of jaundice - ECG • Setting of Ventilators • Phototherapy • Use of Radiant warmer and incubators • Centrifuge machine • Flux meter, Bilimeter, Refractometer • Laminar Flow • Procedures for prevention of infections: - Hand washing - disinfections & sterilization - surveillance - Fumigation |
• Neonatal assessment report • Case study report |
• Clinical evaluation • Case study and NICU visit report |
|
Neonatal Surgical Ward |
10 weeks |
Perform pre and postoperative care for neonates undergoing surgery Perform counselling of parents and family members |
• Preparation of neonates for surgery • Perform postoperative care • Airway Management • Application of Oropharyngeal Airway • Oxygen therapy • CPAP (Continuous Positive Airway Pressure) • Care of Tracheostomy • Endotracheal Intubation • OG (Orogastric) tube insertion • Gavage feeding • Gastric lavage • Administration of Drugs: - I/M, - IV injection, - IV Cannulation & fixation - Infusion pump - Calculation of dosages - Neonatal formulation of drugs - use of tuberculin/insulin syringes - Monitoring fluid therapy - Blood transfusion. • Collection of specimens. Parental Guidance and Counselling |
• Health Talk |
• Clinical evaluation • Case study |
|
Labour Room (Newborn Care Corner) |
04 weeks |
Provide immediate care to newborn and perform Neonatal resuscitation to those in need |
• Neonatal Resuscitation • Immediate Care of Newborn • APGAR Score • Weighing the baby • Administration of Vitamin K • KMC • Skin to skin contact • Breast feeding |
• Nursing Assessment |
• Clinical Evaluation |
|
Post-natal ward |
04 weeks |
Provide nursing care for neonates and mothers of neonates admitted in Post-natal ward |
• Anthropometric assessment • Newborn examination • Feeding-management of - Breast feeding & Breast feeding counselling - artificial feeding - TPN • Thermoregulation • Axillary temperature • Management of thermoregulation & control • Diet planning • Counseling for parents |
• Health talk Case presentation |
Clinical evaluation |
|
KMC Ward/ Human Milk Bank |
04 weeks |
Prepare neonates and mothers/parents for KMC |
• Kangaroo Mother Care (KMC) • Expression of breast milk • Health education to parents |
• Drug study • Health Talk |
• Clinical Evaluation • Evaluation of health talk |
|
OPD |
04 weeks |
Assist in examination of the neonates with various disorders Assist in diagnostic procedures |
• History taking • Physical examination • Health education • Observing and assisting in - Echocardiogram - Ultrasound head • ROP screening (Retinopathy of prematurity) |
• Health assessment report - history taking and physical examination |
• Clinical Evaluation |
Appendix-1
Skill Lab Requirements
Note: In addition to the basic skill lab requirement of College of Nursing, the following are necessary.
|
S.No. |
Skill Lab Requirement |
No/s |
Skill |
|
1. |
Newborn Mannequin having Squeeze bulbs for simulation of cord pulsation, spontaneous breathing, auscultation of heart sound and cry |
02 |
Essential New Born Care |
|
2. |
External umbilical cords |
04 |
|
|
3. |
Umbilical ties |
06 |
|
|
4. |
Baby sheets or towels |
04 |
|
|
5. |
Head cap |
02 |
|
|
6. |
Neonatal mucus sucker (easy to open, clean, autoclavable and reusable) |
02 |
|
|
7. |
Training Stethoscope |
02 |
|
|
8. |
Normal New Born Baby Mannequin - of normal weight with moving head, flexible upper and lower limbs |
02 |
Kangaroo Mother Care |
|
9. |
Baby cap, nappy, mittens, socks |
02 |
|
|
10. |
Kangaroo Mother Care (KMC) dress/shawl |
02 |
|
|
11. |
Bed sheet (for wrapping the mother and baby) |
02 |
|
|
12. |
Digital Thermometer |
10 |
Thermoregulation |
|
13. |
Radiant Warmer |
|
|
|
14. |
Mattress |
03 |
|
|
15. |
Skin temperature probe (with connection cable) |
06 |
|
|
16. |
Spare heating element |
03 |
|
|
17. |
Spare set of fuses |
10 |
|
|
18. |
Power cord and fittings with at least 10 meters wire |
01 |
|
|
19. |
Basic Nursing care articles |
- |
Basic and advance nursing care |
|
20. |
Advance Nursing care articles |
- |
|
|
21. |
B owls with lid 10 cm |
10 |
Instruments for various procedures |
|
22. |
B owls 10 cm |
10 |
|
|
23. |
Instrument Tray with lid |
10 |
|
|
24. |
P lain Artery Forceps |
10 |
|
|
25. |
Toothed Artery Forceps |
10 |
|
|
26. |
Plain Dissecting Forceps |
10 |
|
|
27. |
Toothed Dissecting Forceps |
10 |
|
|
28. |
Sponge Holding Forceps |
10 |
|
|
29. |
Towel clip |
20 |
|
|
30. |
Stethoscope with neonatal chest piece |
10 |
Monitoring Equipment in NICU |
|
31. |
Non-invasive BP monitors |
5 |
|
|
32. |
Pulse oximeter |
5 |
|
|
33. |
Room thermometers |
5 |
|
|
34. |
Mechanical weighing scale |
5 |
|
|
35. |
Electronic weighing scale |
5 |
|
|
36. |
Intubation head |
5 |
Resuscitation equipments |
|
37. |
Self-inflating bag with mask of preterm & term newborns |
5 |
|
|
38. |
Foot operated suction apparatus/mucus trap |
5 |
|
|
39. |
Oxygen cylinders |
5 |
|
|
40. |
O2concentrators |
5 |
|
|
41. |
Laryngoscope 5 |
|
|
|
42. |
Paediatric instrument set |
5 |
Umbilical venous catheterization |
|
43. |
Umbilical catheters: Fg 5.0 > 1000 gram infant or Size Fg 5 feeding tube if umbilical catheters are not available |
10 each |
|
|
44. |
Intravenous cannula: size Fg 24 |
10 |
Peripheral intravenous cannulation |
|
45. |
Intra-osseous needle Fg 18 |
10 |
|
|
46. |
Skin preparation solution |
2 |
|
|
47. |
Three way tap and extension tubing primed with 0.9% sodium chloride |
5 |
|
|
48. |
Arm board |
5 |
|
|
49. |
Syringes: 2 mL, 5 mL, 10 mL & 20 mL |
10 each |
Drug and fluid administration
|
|
50. |
Needles: Fg 19, Fg 21, Fg 23, Fg 25 and blunt drawing up needles |
10 each |
|
|
51. |
Adrenaline 1 : 10,000 concentration (0.1 mg/mL) |
5 |
|
|
52. |
Volume expanders: 0.9% sodium chloride |
5 |
|
|
53. |
IV Cannula (24 G, 26 G) |
5 each |
|
|
54. |
BT Set |
20 |
Blood Transfusion |
|
55. |
Normal Saline |
20 |
|
|
56. |
Blood/Blood component simulator |
20 |
|
|
57. |
Blood bag carriage/container |
05 |
|
|
58. |
Intravenous cannula 16/18 F |
30 |
|
|
59. |
IV simulator arm for transfusion |
01 |
|
|
60. |
Standard safety Protection Devices |
20 |
Sets Infection Control |
|
61. |
Nutrition Lab for preparation of diet 01 |
|
|
|
62. |
Barrier Nursing Unit |
01 |
|
|
63. |
H and washing area |
01 |
|
|
64. |
Biomedical waste disposal unit |
01 |
|
|
65. |
Records (Consent Form, Clinical charts, Nurses Note) |
- |
Recording |
|
66. |
LCD TV |
01 |
Video assisted Demonstration |
|
67. |
Health Teaching modules for parents |
- |
Health Teaching |
Appendix-2
Assessment Guidelines (Theory And Practicum)
I. Theory A. Internal Assessment Neonatal Specialty Nursing (Part I: Neonatal Nursing I including Foundations and Part II: Neonatal Nursing II) - Total: 25 marks • Test Papers and Quiz: 10 marks • Written assignments: 10 marks (Code of ethics relevant to Neonatal nursing practice, literature review on EBP in Neonatal nursing/Infection control practices, Nutritional care of neonates) • Group project: 5 marks B. External/final Exams Neonatal Specialty Nursing (Part I: Neonatal Nursing I including Foundations and Part II: Neonatal Nursing II) - Total: 75 marks Part I: 35 marks (Essay type 1 × 15 = 15 marks, Short answers 4 × 4 = 16 marks, Very short answers 2 × 2 = 4 marks) and Part II: 40 marks (Essay type 1 × 15 = 15 marks, Short answers 5 × 4 = 20 marks, Very short answers 5 × 1 = 5 marks) II. Practicum A. Internal Assessment - 75 marks • OSCE: 25 marks (End of posting OSCE - 10 marks + Internal end of year OSCE - 15 marks) • Other Practical: 50 marks(a) Practical assignments: 20 marks (Clinical presentation and Case study report - 5 marks, Counseling report/visit report - 5 marks, Drug study report - 5 marks, and Health talk - 5 marks)
(b) Completion of procedural competencies and clinical requirements - 5 marks
(c) Continuous clinical evaluation of clinical performance - 5 marks
(d) Final Observed Practical Exam (Actual performance in clinicals) - 20 marks
B. External/final Exam: 150 marks OSCE: 50 marks, Observed Practical: 100 marks Detailed guidelines are given in GuidebookAppendix-3
Clinical Log Book
(Specific Procedural Competencies/Clinical Nursing Skills)
|
S.No. |
Specific Competencies/Skills |
Number Performed/ Assisted/Observed (P/A/O) |
Date and Signature of the Faculty/ Preceptor |
|
I |
Foundations To Neonatal Specialty Nursing |
||
|
1 |
Preparation of parental education materials |
P |
|
|
2 |
Education plan for teaching parents of neonates with clinical condition(s) |
P |
|
|
3 |
Preparation of duty roster for nursing officers/staff nurses |
P |
|
|
4 |
Writing literature review/systematic review (Identify evidence based nursing interventions/practices) |
P |
|
|
5 |
Preparation of a manuscript for publication/paper presentation |
P |
|
|
6 |
Group research project |
P |
|
|
|
Topic: |
|
|
|
II |
Neonatal Specialty Nursing |
||
|
1 |
Health Assessment |
||
|
1.1 |
History taking |
P |
|
|
1.2 |
Neonatal examination |
P |
|
|
2 |
Diagnostic Procedures |
|
|
|
2.1 |
Echocardiogram, Ultrasound head |
O |
|
|
2.2 |
ROP screening (Retinopathy of prematurity) |
A |
|
|
2.3 |
Advanced neonatal life support |
A |
|
|
2.4 |
Lumbar Puncture |
A |
|
|
2.5 |
Arterial Blood gas |
A |
|
|
2.6 |
ECG Recording |
A |
|
|
2.7 |
Arterial B P monitoring |
A |
|
|
3 |
Neonatal Intensive Care Unit |
||
|
3.1 |
Gestation age assessment |
P |
|
|
3.2 |
Detection of life threatening congenital abnormalities |
P |
|
|
3.3 |
Assessment of jaundice |
P |
|
|
3.4 |
Setting of Ventilators |
P |
|
|
3.5 |
Use of Radiant warmer and incubators, Phototherapy |
P |
|
|
3.6 |
Use of Laminar flow |
P |
|
|
3.7 |
Procedures for prevention of infections: - Hand washing - disinfections & sterilization - surveillance - fumigation |
P |
|
|
3.8 |
TPN |
P |
|
|
4 |
Neonatal Surgical Ward |
||
|
4.1 |
Oxygen therapy |
P |
|
|
4.2 |
CPAP (Continuous Positive Airway Pressure) |
P |
|
|
4.3 |
Care of Tracheostomy |
P |
|
|
4.4 |
Endotracheal Intubation |
A |
|
|
4.5 |
OG (Orogastric) tube insertion |
P |
|
|
4.6 |
Gavage feeding |
P |
|
|
4.7 |
Gastric Lavage |
P |
|
|
4.8 |
Administration of Drugs through various routes |
P |
|
|
4.9 |
IV Cannulation & fixation |
P |
|
|
4.10 |
Infusion pump |
P |
|
|
4.11 |
Calculation of dosages |
P |
|
|
4.12 |
Blood transfusion |
P |
|
|
4.13 |
Collection of specimens |
P |
|
|
5 |
Labour Room (Newborn Care Corner) |
||
|
5.1 |
Neonatal Resuscitation |
A |
|
|
5.2 |
Immediate Care of Newborn |
P |
|
|
5.3 |
APGAR Scoring |
P |
|
|
5.4 |
Weighing the baby |
P |
|
|
5.5 |
Administration of Vitamin K |
P |
|
|
5.6 |
KMC |
P |
|
|
5.7 |
Skin to skin contact |
P |
|
|
5.8 |
Breast feeding |
P |
|
|
6 |
Post-Natal Ward |
||
|
6.1 |
Anthropometric assessment |
P |
|
|
6.2 |
Newborn examination |
P |
|
|
6.3 |
Breast feeding & Breast-feeding counselling |
P |
|
|
6.4 |
Artificial feeding |
P |
|
Appendix 4
Clinical Requirements
|
S.No. |
Clinical Requirement |
Date |
Signature of the Faculty/Preceptor |
|
1 |
Health Talk (OPD, Ward/KMC Ward) |
|
|
|
1.1 |
Topic: |
|
|
|
1.2 |
Topic: |
|
|
|
2 |
Counseling Parents & Relatives Counseling Report - 1 |
|
|
|
3 |
Health Assessment |
|
|
|
3.1 |
Gestational Age Assessment History and Neonatal Examination (Two written reports) 3.1.1 Normal Newborn 3.1.2 Sick Newborn |
|
|
|
4 |
Journal Club/Clinical Seminar Topic: |
|
|
|
5 |
Case Study/Clinical Presentation and Report - Medical Neonatal Ward - 1 & Surgical Neonatal Ward - 1 (Nursing/Interdisciplinary Rounds) |
|
|
|
5.1 |
Name of clinical condition: |
|
|
|
5.2 |
Name of clinical condition: |
|
|
|
6 |
Drug Study, Presentation and Report (Two written reports for submission) |
|
|
|
6.1 |
Drug name: |
||
|
6.2 |
|
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|
|
6.3 |
|
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|
|
6.4 |
|
|
|
|
7 |
Designing NICU/KMC Ward |
|
|
|
8 |
Visits - Reports |
|
|
|
8.1 8.2. |
National/Regional SNCU National/Regional Human Milk Bank |
|
|
Signature of the HOD/Principal
Appendix 5
Clinical Experience Details
|
Name of Clinical Area |
Clinical Condition |
Number of Days care given |
Signature of the Faculty/Preceptor |
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Signature of the HOD/Principal
