1nursing and Ethics.

NMT 04104
Nursing
&
Ethics
NTA Level 4 Facilitator Guide for Basic
Certificate in Nursing
September 2013
United Republic of Tanzania

Ministry of Health and Social Welfare
Ministry of Health and Social Welfare
Department of Human Resources Development
Nursing Training Section
© Ministry of Health and Social Welfare 2013
Table of Contents
Acronyms...............................................................................................................................................iii
Goals and Objectives of the Training Manual ......................................................................................vii
Overall Goal for training manual ......................................................................................................vii
Objectives for training manual..........................................................................................................vii
Introduction..........................................................................................................................................viii
Module Overview ............................................................................................................................viii
Who is the Module For? ..................................................................................................................viii
How is the Module Organized? .......................................................................................................viii
How Should the Module be Used? ....................................................................................................ix
Module Sessions
Session 1: Introduction to Nursing and Ethics ................................................................................. 1
Session 2: Contemporary Nursing Practice in Tanzania and Worldwide ..................................... 8
Session 3: Models and Theories Used in Nursing.......................................................................... 23
Session 4: Tanzania Nursing Practice Model................................................................................. 36
Session 5: Basic Nursing Procedures ............................................................................................. 43
Session 6: Making Occupied and Unoccupied Beds...................................................................... 48
Session 7: Making Post-Operative Bed.......................................................................................... 53
Session 8: Making Cardiac and Divided Beds ............................................................................... 56
Session 9: Admission and Discharge of a Patient .......................................................................... 60
Session 10: Checking a Patient’s Vital Signs................................................................................... 66
Session 11: Administration of Oral Medicines ................................................................................ 73
Session 12: Administration of Medicine by Injection...................................................................... 77
Session 13: Instillation of Eye, Ear and Application of Ointment ................................................ 81
Session 14: Topical Administration of Medicines ........................................................................... 86
Session 15: Insertion of Suppositories ............................................................................................. 89
Session 16: Administration of Oxygen ............................................................................................ 93
Session 17: Bed Bathing of an Adult Patient ................................................................................... 97
Session 18: Washing a Patient’s Hair in Bed ................................................................................. 101
Session 19: Mouth Care of an Unconscious Patient....................................................................... 104
Session 20: Assisting a Helpless Conscious Patient with Oral Care........................................... 108
Session 21: Care of a Patient with Wounds.................................................................................... 112
NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

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Session 22: Removing Sutures/Clips ............................................................................................. 117
Session 23: Giving and Removing Bedpans and Urinals............................................................... 121
Session 24: Giving and Removing Sputum Mug ........................................................................... 125
Session 25: Collecting Stool/Urine Specimen................................................................................ 129
Session 26: Nasogastric Tube Insertion ......................................................................................... 134
Session 27: Catheterization ............................................................................................................ 138
Session 28: Care of a Dying Patient............................................................................................... 142
Session 29: The Concept of Nursing Process................................................................................. 151
Session 30: The Nursing Process ............................................................................................... 159
Session 31: Physical Assessment ................................................................................................... 166
Session 32: Assessment of an Unconscious Patient ....................................................................... 172
Session 33: Positions Used in Nursing Patients ............................................................................. 176
Session 34: Maintaining Body Mechanics ..................................................................................... 184
Session 35: Legislation Issues in Nursing and Midwifery ............................................................. 189
Session 36: Nursing Legislation Process in Provision of Care ................................................... 193
Session 37: The Nurse’s Code of Professional Conduct ................................................................ 198
Session 38: Professional Responsibilities in Relation to Level of Licensure.............................. 202
Session 39: Moral Conduct in the Nursing Profession................................................................... 207
Session 40: Trustworthiness Towards Patients/Clients.................................................................. 212
Session 41: Principles of Confidentiality ....................................................................................... 215
Session 42: Nursing Ethics and Etiquette....................................................................................... 218
Session 43: Patients’ and Service Providers’ Rights...................................................................... 222
Session 44: Concepts of Tanzania Nursing and Midwifery Council......................................... 227
Session 45: Nursing National and International Organizations................................................. 231
Session 46: Utilities and Various Levels of Nursing...................................................................... 235
Session 47: Advancement and Opportunities.................................................................................240

ii
Acronyms
LCD – Liquid Cristal Display
WHO – World Health Organization
B.C – Before Christ
A.D – Anno Domini
S.R.N – State Registered Nurses
MCHA – Maternal and Child Health Aide
NGT – Nasogastric Tube
NANDA – North American Nursing Diagnoses Association
NMT – Nursing and Midwifery Technician
NTA - National Technical Award
ANA – American Nurses Association

iii
Acknowledgement
The development of the training manuals for Certificate and Diploma in Nursing (NTA Level
4 to 6) has been possible and accomplished through involvement of different stakeholders. The
Ministry of Health and Social Welfare (MoHSW) through the Director of Human Resources
Development sends sincere gratitude to the stakeholders including the coordinating team
(Department of Nursing and Midwifery Training), TNI, through AIHA and the WINONA state
University for funding the activity.
The MOHSW would like to thank all those involved during the process for their valuable
contribution to the development of these training materials. The ministry of Health would like
to thank the Assistant Director for Nursing Training section Mr. Ndementria Vermand, and Ms.
Vumilia B.E Mmari (Coordinator for Nursing and Midwifery Training) who tirelessly led this
important process.
Sincere gratitude is expressed to main facilitator: Mr. Golden Masika, Tutorial Assistant
University of Dodoma for his tireless efforts and Mr. Nicolaus Ndenzako Programme
consultant of AMCA inter consultant in guiding participants through the process. Special
thanks go to the team of contributors representing the Health Training Institutions, hospitals
and Universities. Their participation in meetings and workshops and their inputs in the
development of the content for each module have been invaluable. It is the commitment of
these participants that has made this product possible.
These participants are listed with our gratitude below:
SN Name Title Institution

1. Mary S. Matembo Nurse Tutor Korogwe NTC
2. Elialilia M. Herman Nurse Tutor MT. Meru Hospital
3. Alice Chifunda Nurse Tutor Mbulu NTC
4. Lilian Wilfreda Nurse Tutor KCMC
5. Aselina Milinga Nurse Tutor KCMC
6. Veronica Mahela Nurse Tutor Kahama
7. Samwel Mwangoka Nurse Tutor Mbeya SOTM
8. Hamza S. Matagira Nurse Tutor Kahama NTC
9. Elikana Wallace Nurse Tutor Kolandoto S/Nursing
10. Anna Sangito Pallangyo Nurse Tutor Kahama NTC
11. David Abincha Nurse Tutor Bukumbi NTC
12. Leon S. Mgohamwende Nurse Tutor Tosamaganga NTC
13. Crescent D. Ombay Nurse Tutor Haydom S/Nursing
14. Kizito B. Tamba Nurse Tutor Ndanda S/N
15. Robert E. Moshi Nurse Tutor IMTU college of Nursing
16. Oresta Ngahi Nurse Tutor Muhimbili S/N
17. Aloyce Ambokile Nurse Tutor Kondoa District Hosp.
18. Helma A. Shimbo Nurse Tutor Mwambani NTC
19. Elizabeth G. Chezue PNO N Tutor MOHSW HIS & QAS
20. Hinju Januarius Obstetrian Dodoma Regional Hosp.
21. Manase Nsunza Principal HLT Singida HLTC
22. Ezekiel Amata IMC Facilitator Mpwapwa Hosp.
23. Sostenes D. Ntambuto HLT Tutor SMLS MUHIMBILI
iv
24. Anna Sangito Pallanyo N/Tutor Kahama SN
25. Naomi Kagya NT Muhimbili
26. Aloyce Amboikile Nurse Kondoa
27. Golden Masika Lecturer UDOM
28. Vumilia B.E. Mmari CD-NT MOHSW
29. Upendo kilume Nurse PHN
30. Fatuma Iddi Librarian MOHSW
31. Shango Nasania Nurse Newala
32. George Laisser C/Analyst MOHSW
33. Anande Mungure Nurse Tutor Mbulu NTC
34. Robert Masano Nurse Tutor Nkinga NTC
35. Ambokile Dodoma General Hospital
36. Nolasca Mtega Nurse Tutor Tukuyu School of Nursing
37. Asteria Ndomba Senior Lecturer CUHAS
38. Alfreda Ndunguru
39. Elizabeth Chezua MOHSW
40. Magwaza Charles
41. Ellen Mwandemele
42. Robert Mushi IMTU
43. Anna Mangula Nurse Tutor Mirembe NTC
44. Cesilia Mallya Nurse tutor Newala NTC
45. Helma Shimba
46. Kapaya Andrew TNMC
47. Ntambuto Sostenese
48. Joseph Nkungu
49. Anastazia Dinho
50. Eliaremisa Ayo Nurse Tutor MOHSW
51. Grace Mallya Paediatrician RCHS/GBV/VAC-MOHSW
52. Dr. Tecla Kohi Senior Lecturer MUHAS
53. Dr. Lilian Msele Lecturer MUHAS
Supporting staff:
Daniel Muslim Driver, Ministry of Health and Social Welfare
Fatuma Mohamed Health Librarian, Ministry of Health and Social Welfare
Mbaruku A. Luga Driver, Morogoro School of Public Health Nursing
Roselinda RugemaliraAdm. Secretary, Tanzania Nursing & Midwifery Council
Veronica Semhando Secretary Ministry of Health & Social Welfare
George Laizer System Analyst Ministry of Health & Social Welfare
Silvanus Ilomo System Analyst Ministry of Health & Social Welfare
Violet Mrema Adm. Secretary, Ministry of Health and Social Welfare
Walter Ndesanjo System Analyst, Ministry of Health and Social Welfare
Dr. Gozbert Mutahyabarwa

Ag: Director of Human Resource and Development,

v
Background
In 2007 the Ministry of Health and Social welfare (MOHSW) started the process of reviewing
the nursing curricula at Certificate and diploma level. In 2008 refined and developed NTA
Level 4 to 6 Nursing Curricula and in the same year 2008 started the implementation. The
intention was to comply with the National Council for Technical award (NACTE) Qualification
framework which offers a climbing ladder for higher skills opportunity. Advanced Diploma
awards are not among the awards of the council and do not conform to NACTE framework.
Therefore, institutions offering Advanced Diploma in nursing are required to either offer
Ordinary Diploma (NTA Level 6) or develop its capacity to offer Bachelor’s Degree (NTA
Level 7&8).
These programs have been developed in line with the above consideration aiming at providing
a room for Nurses to continue to a higher learning and achieve advanced skills which will
enable them to perform duties competently. In addition, WHO advocates for skilled and
motivated health workers in producing good health services and increase performance of health
systems (WHO World Health Report, 2006). Moreover, Primary Health Care Development
Program (PHCDP) (2007-15) needs the nation to strengthen and expand health services at ALL
levels. This can only be achieved when the Nation has adequate, appropriately trained and
competent work force who can be deployed in the health facilities to facilitate the provisions
of quality health care services.
In line with these new curricula, the MOHSW supported tutors by developing quality
standardized training materials to accompany the implementation of the developed curricula.
These training materials will address the foreseen discrepancies in the implementation of the
new curricula. NTA level 8 training materials have been developed after Curricula validation
and verification.
This training material has been developed through writers’ workshop (WW) model. The model
included a series of workshops in which tutors and content experts developed training
materials, guided by facilitators with expertise in instructional design and curriculum
development. The goals of Writer’s Workshop were to develop high-quality, standardized
teaching materials and to build the capacity of tutors to develop these materials. This product
is a result of a lengthy collaborative process, with significant input from key stakeholders
(NACTE, MOHSW, AIHA and WINONA University) and experts of different organizations
and institutions. The new training package for NTA Level 4-6 includes a Facilitator Guide and
Student Manual. There are 28 modules with approximately 520 content sessions

vi
Rationale
The vision and mission of the National Health Policy in Tanzania focuses on establishing a
health system that is responsive to the needs of the people, and leads to improved health status
for all. Skilled and motivated health workers are crucially important for producing good health
through increasing the performance of health systems (WHO, 2006). With limited resources
(human and non-human resources), the MOHSW supported tutors by developing standardized
training materials to accompany the implementation of the developed CBET curricula. These
training manuals address the foreseen discrepancies in the implementation of the new curricula.
Therefore, this training manual for Certificate and Diploma program in Nursing (NTA Levels
4-6) aims at providing a room for Nurses to continue achieving skills which will enable them
to perform competently. These manuals will establish conducive and sustainable training
environment that will allow students and graduates to perform efficiently at their relevant
levels. Moreover, this will enable them to aspire for attainment of higher knowledge, skills and
attitudes in promoting excellence in nursing practice.
Goals and Objectives of the Training Manual
Overall Goal for training manual

The overall goal of these training manual is to provide high quality, standardized and
competence-based training materials for Diploma in nursing (NTA level 4 to 6) program.
Objectives for training manual

 To provide high quality, standardized and competence-based training materials.
 To provide a guide for tutors to deliver high quality training materials.
 Enable students to learn more effectively.

vii
Introduction
Module Overview
This module content has been prepared as a guide for tutors of NTA Level 4 for training
students. The session contents are based on the sub-enabling outcomes of the curriculum of
NTA Level 4 Basic Certificate in Nursing.
The module sub-enabling outcome as follows:
2.2.1 Describe basic nursing procedures in health care settings
4.1.1 Comprehend the concept of nursing process
4.1.2 Demonstrate use of nursing process components in providing care to clients/patients
5.1.1 Utilize legislation guidelines in providing nursing and midwifery care
5.1.2 Describe nursing legislation process
5.1.3 Differentiate professional responsibilities in relation to level of licensure
5.1.4 Describe the concepts of nursing profession
5.1.5 Describe contemporary practice of nursing profession in Tanzania and worldwide
5.2.1 Recognize moral conduct in nursing profession
5.2.2 Demonstrate trust worthiness towards patient/clients and other health care workers
5.2.3 Use the principles of confidentiality in rendering health services
5.3.1 Describe components of nursing ethics and etiquettes
5.3.2 Observe patients and service provider rights
5.3.3 Demonstrate abilities in maintaining professional qualities
Who is the Module For?

This module is intended for use primarily by tutors of NTA Level 4 to 6 in nursing schools.
The module’ sessions give guidance on the time and activities of the session and provide
information on how to teach the session to students. The sessions include different activities
which focus on increasing students’ knowledge, skills and attitudes.
How is the Module Organized?

The module is divided into 47 sessions; each session is divided into sections. The following
are the sections of each session:
 Session Title: The name of the session.
 Learning Tasks – Statements which indicate what the student is expected to learn at the
end of the session.
 Session Content – All the session contents are divided into steps. Each step has a heading
and an estimated time to teach that step. Also, this section includes instructions for the
tutor and activities with their instructions to be done during teaching of the contents.
 Key Points – Each session has a step which concludes the session contents near the end
of a session. This step summarizes the main points and ideas from the session.
 Evaluation – The last section of the session consists of short questions based on the
learning objectives to check the understanding of students.
 Handouts are additional information which can be used in the classroom while teaching
or later for students’ further learning. Handouts are used to provide extra information
related to the session topic that cannot fit into the session time. Handouts can be used by
the participants to study material on their own and to reference after the session.
Sometimes, a handout will have questions or an exercise for the participants. The
answers to the questions are in the Facilitator Guide Handout, and not in the Student
Manual Handout.

viii
How Should the Module be Used?
Students are expected to use the module in the classroom and clinical settings and during
self-study. The contents of the modules are the basis for learning Nursing and Ethics.
Students are therefore advised to learn each session and the relevant handouts and worksheets
during class hours, clinical hours and self-study time. Tutors are there to provide guidance
and to respond to all difficulty encountered by students.

ix
x
Session 1: Introduction to Nursing and Ethics
Total Session Time: 60 minutes
Prerequisite
 None
Learning Tasks
By the end of this session, students are expected to be able to:
 Define common terms used in nursing and ethics
 Explain functions and roles of a nurse
 Explain the qualities of the professional nurse
Resources needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 Computer and LCD
 Overheard Projector
SESSION OVERVIEW
Step Time Activity/Method Content
1 5 minutes Presentation Presentation of Session and Learning Tasks

Brainstorming/ Definition of the Common Terms in Nursing
2 10 minutes
Buzzing and Ethics
3 20 minutes Presentation Functions and Roles of a Nurse
4 15 minutes Presentation Qualities of Professional Nurse
5 5 minutes Presentation Key Points
6 5 minutes Presentation Evaluation
SESSION CONTENT
Step 1: Presentation of Session Title and Learning Tasks (5 minutes)
READ/ASK students to read the learning tasks and clarify.
ASK student if they have any question before proceeding
NMT 04104 Nursing and Ethics

NTA Level 4, Semester 1 1 Session 1: Introduction to Nursing and
Ethics
Step 2: Common Terms in Nursing (10 minutes)
DIVIDE students to be divided into small manageable groups
ASK students to discuss in groups on the common terms in nursing for 4 minutes
ASK students to provide their responses for 6 minutes after discussion
CLARIFY and summarize by using the contents below
Introduction
 The concepts of nursing practice derived from various aspects of care and its application
to the professional.
 The practice of nursing is conducted by skilled personnel trained with special knowledge
on how to perform various nursing practice.
 Principle of nursing practice is bind by the ethical code of conduct which enables an
individual to value the life of each other within the professionals and clients in the health
care setting.
 Nurses as professionals are connected to each other by common experiences and sharing,
language and body of knowledge through communication and interpersonal relationship
Definitions
 A nurse Is a registered person with specialized education program capable of working
independently in solving patient’s care problems and is able to teach and work
successfully with others in the medical care team OR Is a person with good character,
experienced a sense of calling and who is well trained to meet the physical needs of
patients ( Nightingale definition)
 Nursing is an art and a science where by a professional nurses learns and acquires
competencies to deliver compassion care and respect to patients. OR, Is the protection,
promotion, and optimization of health and abilities, prevention of illness and injury,
alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities and populations ( ANA, 2003)
 Practice is the art of doing something in accordance to set standards
 Caring is a universal phenomenon that influences the ways in which people think, feel
and behave in relation to one another. In nursing, caring is an inherent features of nursing
practice that creates possibility, determination and involvement to others events, things or
matters to a person.
 Profession Is a group (vocational or occupational) that required specialized education and
intellectual knowledge
 Nursing profession Is a field of practice whereby individual nurses has acquired all
competencies and demonstrate ongoing criteria of a profession. A professional nurse has
the following criteria:
o Provide unique service to society
o Wok as intellectual and distinguished person with body of knowledge
o Expand body of knowledge in nursing to meet the demands of the health care
deliveries
o Responsible and accountable to public services
o Undergoing a period of education including both theory and practice

Ethics
o Autonomy and ability to develop policy about the discipline and control of the related
activity
o Adhere to code of ethics and conduct
o Motivate other member for carrier choice and development
o Share common attitude, identity and values
 Fundamentals of nursing: Are basic principles and practices of nursing.
 Patient: Is a person receiving or registered to receive a medical treatment
 Client: Is a person using the services of a professional person or organization
 Health: Is the state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity (WHO)
 Hospital: Is an institution where sick or injured are given medical or surgical care. These
institutions are categorized according to the types and levels of health care services
provided
 Environment: Is the complex of physical, social and cultural conditions that affects the
nature of individual or community
 Ethics: Is a system of moral principles or standards governing conduct. It is concerned
with judgments about what is right or wrong conduct in relation to moral conflicts.
 Etiquette: Is the code of behavior that delineates expectation for social behavior
according to the contemporary conversion nouns within a society and social group.
 Code: Is an authoritative system of written rules, which are similar to Law and are
binding and formulated to regulate behavior
 Principle: Is an accepted role of action for conducts which guide the standards of
performance
 Ethical Principle: Ethical Principle is the process in decision making and problem
solving undertaken by a person with a sound moral principle.
 Code of ethics: Is the rule that governing and regulates the conduct of members
 Code of conduct: Provides a framework that defines the core value and standards which
professional must follow.
 Values: Refers to something that is perceived as desirable or „‟the way thing s ought to
be”.
 Physician: Is a person who has successfully completed a course of medical studies and is
licensed to practice medicine in a particular jurisdiction.
 Dentist: Is a person who trained and licensed to diagnose, treat and prevent dental
problem.
 Physiotherapist: Is a person who trained and licensed to assist client with
musculoskeletal problems by means of heat, water, exercise, massaging and the use of
electrical current
 Pharmacist: Is a person who is trained and licensed to prepare and dispensing
pharmaceuticals in hospitals and community settings.
 Laboratory technician: Is a person who is trained and licensed to examine specimens
from the client/patient such as blood, urine, feaces and discharges from wound to provide
exactly information that facilitate the medical diagnosis and prescription of proper
therapeutics.
 Radiologist: Is a person who is trained and licensed to assist with a variety of x-ray film
procedures from simple chest radiography to more complex fluoroscope
 Dietitian or Nutritionist: Is a person who has special knowledge about nutrition and
food.
 Social worker: Is a person with knowledge and skills on counseling clients and support
person about social problems at all settings.
Ethics
Step 3: Functions and Roles of a Nurse (20 minutes)
 Nurses perform a wide range of clinical and non-clinical functions necessary to the
delivery of health care, and may also be involved in medical and nursing research.
 Both nursing roles and education were first defined by Florence Nightingale
The following are the prescribed nursing roles and functions

 Caregiver/ Care provider: The nurse provides direct care to client when is unable to
meet their own needs. Specific activities includes
o Nurture, comforter, provider
o Feeding
o Bathing
o Administering medicine
o “mothering actions” of the nurse
 Teacher: provides information and helps the client to learn or acquire new knowledge
and technical skills.
o Each interaction in nursing is an opportunity for education both client and nurse as
they can learn from each other.
o Teaching can be informal, formal, intentional or incidental
o Encourages compliance with prescribed therapy, promotes healthy lifestyle and
interprets information to the client
 Counselor: helps client to recognize and cope with stressful psychological or social
problems; to develop and improve interpersonal relationships and to promote personal
growth
o Provides emotional, intellectual and psychological support to a client to identify
problem and find solution
o Focuses on helping a client to develop new attitudes, feelings and behaviors rather
than promoting intellectual growth
o Encourages the client to look at alternative behaviors recognize the choices and
develop a sense of control, effective counseling is holistic, that addresses the
individual’s emotional, spiritual, and cognitive dimensions
 Change agent: Initiate changes to make things happen or assist clients to make
modifications in themselves or in the system of care.
 Client advocate: Involves concern for and actions in behalf of the client to bring about a
change
o Promote what is best for the client, ensuring that the client’s needs are met and
protecting the client’s right
o Provide explanation in clients language and support clients decisions
 Manager: makes decisions, coordinates activities of others, allocate resources, evaluate
care and personnel
o Plans give direction, develop staff, monitors operations, give the rewards fairly and
represents both staff and administrations as needed
 Researcher: participates in identifying significant researchable problems
o Participates in scientific investigation and must be a consumer of research findings
o Must be aware of the research process, language of research, a sensitive to issues
related to protecting the rights of human subjects

Ethics
 Resource person: The nurse functions as a resource person by providing skilled
intervention and information. Clients health status is considered as way to access resource
and making referral that are needed for improvement.
Expanded roles of the nurse in the professional practice, a nurse can function as a specialist
person in specific area of nursing professional, these area are:
 Clinical Specialists: is a nurse who has completed a master’s degree in specialty and has
considerable clinical expertise in that specialty.
o She provides expert care to individuals, participates in educating health care
professionals and ancillary, acts as a clinical consultant and participates in research.
 Nurse Practitioner: Is a nurse who has completed either as certificate master’s degree in
a specialty and is also certified by the appropriate specialty program or an organization.
o She is skilled at making nursing assessments, performing P. E., counseling, teaching
and treating minor and self- limiting illness.
 Nurse-midwife: a nurse who has completed a program in midwifery; provides prenatal
and postnatal care and delivers babies to woman with uncomplicated pregnancies.
 Nurse anesthetist: A nurse who completed the course of study in an anesthesia school
and carries out pre-operative status of clients.
 Nurse Educator: A nurse usually with advanced degree, who teaches in clinical or
educational settings, teaches theoretical knowledge, clinical skills and conduct research.
 Nurse Entrepreneur: A nurse who has an advanced degree, and management of health-
related business.
 Nurse administrator: A nurse who functions at various levels of management in health
settings; responsible for the management and administration of resources and personnel
involved in giving patient care.
Step 4: Qualities of a Professional Nurse (15 minutes)
 Nursing is considered as a holy profession, serving the human being.

 This profession demands skill, hardworking and devotion.
To become a good nurse, a person should have the following qualities that portray
professional criteria:
 Should have a sound knowledge of the nursing profession, obtained from a reputed
institute.
o Should always be ready to learn more.
o As a nurse is more frequently in contact with the patients should have excellent
communication skills.
o These include speaking as well as listening skills.
 The nurse should be able to openly talk with the patients and their family members
in order to understand their needs and expectations
o Should be able to explain the treatment given to the patient.
o Should be alert every moment about the condition of a patient.
o Should be able to notice a minor change in the patient’s health status.
 A good nurse should be emotionally stable
o Nursing is a very stressful job. Every day the nurses witness severe traumatic
situations, surgeries and deaths.
o The nurse should be mentally strong and should not get disturbed by such incidences.
Good presence of mind is crucial in the nursing profession.

Ethics
o In any critical condition or medical emergency, if the doctor is not there, then the
nurse should not get confused. Should be confident enough to take the correct
decisions.
 Kindness and empathy are the qualities that every nurse should possess
o The nurse should be calm and kind to the patients, even if they are aggressive.
 A good nurse should be highly qualified and trained.
o Good professional skills are a must for the nurse
o Watchfulness is an important quality of a good nurse
o The nurse should understand the pains and suffering of patients
o A good nurse should be flexible about his/her working hours and responsibilities
o Should provide comfort and sympathy to the patients, instead of getting angry with
them.
o Medical emergencies can occur at any time. Nurses often have to extend their duty
hours, work in overnight shifts, or work on weekends too.
 A good nurse should have a strong physical endurance
o Should be able to perform a number of taxing maneuvers, stand up for a long period
of time or lift heavy objects/people on a daily basis.
 A nurse should have a respect for people and rules-
o Should be devoted to the profession.
o Should be aware of different cultures and traditions and confidentiality requirements
of the patients. He/she should respect the wishes of the patients.
 A nurse should be active and cheerful
o Her/his presence should make the patient relaxed and comfortable.
o The nurse’s pleasant appearance can reduce the patient’s stress and pains.
o His/her voice should be soft and gentle.
Step 5: Key points
 Nursing profession is a field of practice whereby individual nurses has acquired all
competencies and demonstrate ongoing criteria of a profession
 Caring is the fundamental values of health which carried by a professional nurse who is
qualified and responsible to work
 Nursing functions is demonstrated in variety of roles that needed to be carried every day
 To become a good nurse, a person must have the qualities such as compassion,
interpersonal skill, presence of mind and commitment.
Step 6: Evaluation:
 What is the professional nurse?

 What are the functions and roles of a nurse
 What are the behaviors demonstrated by a nurse with qualities?
ASK students if they have any comments or need clarification on any points

Ethics
References
DeLaune, S. C., & Ladner, P. K. (2002). Fundamentals of nursing: Standards & practice
(2nd ed.). USA: Delmar Cengage Learning.
Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in
nursing theory and application (6th ed.). USA: Lippincott Williams & Wilkins.
Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). USA: Mosby.
TNMC. (2007). Code of professional conduct for nurses and midwives in Tanzania.
Dar es Salaam: Tanzania.
TNMC. (2009). Nursing ethics: A manual for nurses. Dar es Salaam: Tanzania.

Ethics
Session 2: Contemporary Nursing Practice in Tanzania
and Worldwide
Pre-requisites
 None
Learning Tasks
 Explain the historical background of nursing world wide
 Explain the historical background of nursing in Tanzania
 Explain the health service delivery in Tanzania
Resources needed
 Laptop and LCD
 Overhead projector
SESSION OVERVIEW
1 5 minutes Presentation Presentation of Session Title and Learning Tasks

Presentation/
2 40 minutes Historical Background of Nursing World Wide
Discussion
Presentation
3 40 minutes Historical Background of Nursing in Tanzania
Brainstorm
4 25 minutes Presentation Health Service Delivery Systems in Tanzania

READ or ASK students to read the learning tasks and clarify
ASK students if they have any question before proceed

NTA Level 4, Semester 1 8 Session 2: Contemporary Nursing Practice
in Tanzania and Worldwide
Step 2: Historical Background of Nursing Worldwide (40 minutes)
Activity: Brainstorming (10 minutes)
ASK students to brainstorm on the history of nursing in worldwide for 3 minutes
ALLOW few students to provide their responses
WRITE their responses on the flip chart/board
CLARIFY and summarize using the content below
Nursing in the Ancient Times

 Nursing did not exist as a unique discipline before the birth of the Christian Era
 The nursing which existed was that of a mother caring for her sick child or relative
 During those days illnesses were believed to be the result of the anger of gods or the
work of evil spirits
The Ancient Egypt, 4000 B.C
 During this time the priests were the healers
The Babylonia, 2000 B.C
 The people looked at diseases as being the result of sin
The Indians, 1000 to 800 B.C
 The Indians had a highly developed culture and good sanitation
The Jews
 The Jewish race had the finest record in hygiene and sanitation
 They had also a good knowledge of Anatomy and Physiology
The Greeks, 1200 B.C
 Many “Temple – hospitals” were built in memory of the god Aesculapius
 The usual method of deciding any particular treatment was that the patient, on entering
the hospital, prayed to the god Aesculapius
The Romans, 800 B.C.
 They were influenced by the Greek medicine
 The “Valetudinarians” were building in which the soldiers and slaves were treated and
cared for in order to increase manpower
The Christian Era, 50 A.D.
 The early Christians were inspired by the teaching of Christ
 Christ taught to help each other like brothers and sisters
 Service to the sick and the poor was service to God
 The bishops formed the religious orders of DEACONS AND DEACONESSES
The Dark Period of the Nursing, (18th Century.)
 Despite of new discoveries and great scientific development in medicine, the religious life
of the community was shallow
 Only a few people were ready to join religious Congregations and those who joined were
illiterate

Development of Modern Nursing, (19thCentury)
Four types of organization developed gradually in order to improve the deteriorated care for
the sick
 The Catholic Religious Congregations
 Lutheran Deaconesses
 Civil Orders Especially the Red Cross
 Civil Nursing 1820 – 1910 Florence Nightingale
o Is the pioneer in Nursing Education
o In 1860 she founded the first nursing school at St. Thomas Hospital, London
o By the middle of 18th century and the beginning of 19th century, nursing services
started to be delivered by civil nurses – women who did not belong to religious
congregations
Refer student hand out 2.1 More details on historical background of nursing
worldwide
Step 3: The Historical Background of Nursing in Tanzania (40 minutes)
ASK students to brainstorm on the history of nursing in Tanzania for 3 minutes
 In Tanzania traditional, the care of patients and women in child birth was carried out by
elder, married women in the community
 Western medicine was brought to Tanzania by then Tanganyika by the missionaries of the
different churches
 At the beginning the Africans preferred to trust their traditional midwives
 Therefore the missionaries sought for cooperation with these traditional midwives
 They taught them personal hygiene by using soap and water and also simple midwifery
techniques
Nursing Training in Tanzania

 In 1925-African District Sanitary Inspectors were trained in Dar es Salaam, Tanga and
Tabora
 The students were taught Anatomy, Physiology, Elementary Medicine, Minor Surgery
and Dental Practice
 In 1936 the course for Dispenser (later called Medical Assistants)
 As young men and women had some education at the mission primary schools, were
trained to become nurses
 It was not difficult to obtain young men for the training, but there was strong opposition
to the idea of young women being allowed to attend child birth or to nurse male patient
 From 1930 to 1939 Several missions in Tanganyika took up the training of nurses
 At this time, a Matron in Chief was appointed
The progress in Nursing Education continued as follows
 In 1947 the first group of girls were trained as nurses by the government at Sewa Haji
Hospital in Dar es Salaam
 From 1950 – 1960 Thirteen school for nursing training were existing
 The nursing schools run by the missions as well as government were: Mweka, Tanga
Princess Margareth in Dar es Salaam, Mvumi, Peramiho, Kiomboi, Magila, Ndolage,
Kolandoto, Mnero, Sumve and Kongwa
 In 1951 a new course with an annual intake of 12 students was established at Tukuyu to
train Health Nurses
 The course took two years, and included Midwifery, Child Care Nursing, Nutrition,
Hygiene, First Aid and domestic science
The Tanganyika Nurses and Midwives Council

 In the year 1952 the Tanganyika Nurses and Midwives Council was set up and enacted in
1953 by the act of Parliament as a “Statutory” body to govern the affairs of nurses. In
1997 the profession was regulated under the reviewed Tanzania Nurses and Midwives
Registration Act of 1997. Currently the profession is regulated through Tanzania Nursing
and Midwifery Act of 2010
 In 1956 the medium of instruction in nursing schools was changed from Swahili to
English except in the Health Nursing Training Schools at Tukuyu
 After the independence in 1961, there were few European nurses left
 One year up-grading course was introduced by the Ministry of Health for registered
nurses and midwives
 In 1963 this course was discontinued
 A new nursing syllabus was introduced, where by public health, midwifery and general
nursing were integrated for the purpose to prepare an “all-purpose nurse” who could
work in a general hospital, maternity ward or clinic
 In 1964 a 1-year up-grading course in a new format was introduced, the candidates were
of 2 types; (Grade A & B)
 In 1966 a new syllabus was prepared which reverted to the old system of separate courses
for General Nursing which lasted 3 years and Midwifery one year, designed for primary
school leavers
 They were also eligible for registration in some outside commonwealth countries, such as
England and Wales as State Registered Nurse (S.R.N)
Up - Grading Courses
 In 1970 the up-grading programme changed
 This time it was for grade ‘B’ nurses with a minimum working experience of 3 – 4 years
 The course lasted for one and a half year
 After completion of the course they used the title of “Staff Nurse
 With the increasing demand for public Health Nurses, the former MCHA were upgraded
to Public Health Nurse ‘B’ for two years
 From 1973 to 1986 Specialist schools of nursing were established such as Ophthalmic,
Pediatric, Operating Theatre Management, public health, mental health and Nurse tutors

Bachelor of Science Degree and Masters Degree in Nursing
 In 1989 the Bachelor of Science Degree in Nursing started at the University of Dar es
Salaam
 The course was under the Faculty of Medicine, Muhimbili Medical Centre Candidates
eligible for the course are:
o Pre-service candidates, Form VI leavers studied for four year
o In–service candidates, Diploma in Nursing studied for three years
 From 1998 to 2009 courses on bachelor of Science in Nursing established at Hubert
Kairuki Memorial University, Agha-Khan University, Tumaini University, IMTU,
Dodoma University and St John’s University
 In 2007, Masters degree in nursing were established at Muhimbili University, School of
Nursing
Refer student hand out 2.2 More details on historical background of nursing
Tanzania
Step 4: Health Service Delivery Systems in Tanzania (25 minutes)
 Health services delivery system in Tanzania defined as the totality of services offered by
all health disciplines with the primary purpose of caring all clients with health problems.
 The health policy set a mechanism and structure of health care delivery in all setting at all
levels including government and non government health facility.
 The concept of public - private partnerships and involvement of all health development
partners is clearly elaborated in health policy
 The structure of health services delivery divided into various levels of health facilities in
the country is as follows:
o Primary level health care facility is responsible to deliver health promotion,
Prevention, Continuing care for common health problems, integrates and explains
clients /family health problems and gives adequate attention on psychological and
social dimensions. This type of services delivered at Village Health Post,
Dispensaries, and Health centres and Districts hospitals
o Secondary level health care facility provides medical and surgical treatment by
specialists
o Regional Hospitals are the type of facilities serves as referral hospitals within their
respective regions, the hospitals have specialists in various fields to offer the
specialized and additional services
o Tertiary level of health care facility which provide advanced specialized diagnostic
and therapeutic and rehabilitation. Referral/Consultant hospitals are the highest level
of hospital services in the country presently there are four referral hospitals namely
Muhimbili National Hospital which cater the eastern zone, Kilimanjaro Christian
Medical Centre (KCMC) which cater for the northern zone, Bugando Hospital which
cater for the western zone and Mbeya Hospital which serves the Southern highland
zone

Step 5: Key Points
 Studying historical background of nursing enable nurses to be aware on the previous

situations and the activities carried to ensure the practice of nursing
 It also helps to develop interest for those who are in the professional to put more effort to
improve the practice according to current social economic trends as well motivating more
new enrollment.
Step 6: Evaluation
 How will you differentiate nursing practice between nightingale period and current period
 What are the factors influencing rapid changes in nursing practice
 What are the levels and types of services offered in health delivery system
References
Bunker Rosdahl, C. (1999). Basic nursing (7th ed.). New York: Lippincott Williams &
Wilkins.
Kozier, B., Erb, G., Blais, K., & Wilkinson, J. M. (1995). Fundamental of nursing: Concepts,
process and practice (5th ed.). Oakland, CA: Wesley.
KMTC-VVOB. (2009). Skills lab project: Nursing procedure manual. Kenya.
Lynn, P. (2011). Taylor’s clinical nursing skills: A nursing process approach (3rd ed.).
New York: Lippincott Williams & Wilkins.
MOHSW. (2008). Basic nursing procedures: A manual for nursing practice in Tanzania
(3rd ed.). NCP: KIUTA.
Moshi, N., & Karungura, J. (2005). Basic nursing procedures. KCMC Nursing
Profession.
Paulinus, S. (2004). Basic nursing care (2nd ed.). Tanzania: Ndanda-Peramiho:Benedictine.
Rider Ellis, J. (1992). Basic nursing skills (5th ed.). New York: Lippincott Williams &
Wilkins.
Thomas, C. (1993). Taber’s cyclopedic medical dictionary. Philadelphia: F. A. Davis.

Handout 2.1: Historical Background of Nursing Worldwide
Nursing in the Ancient Times

 Nursing did not exist as a unique discipline before the birth of the Christian Era
 The nursing which existed was that of a mother caring for her sick child or relative
 During those days illnesses were believed to be the result of the anger of gods or the
work of evil spirits
 Special ceremonies of witchcraft were required in order to detect, prevent or cure a
disease
 A magician was a person who was trained in this art and it was passed on from
generation to generation
 This is still seen to-day in some areas in Africa and Asia
The Ancient Egypt, 4000 B.C

 During this time the priests were the healers
 The healing treatment included prayers and sacrifices
 The actual care of the patients, such as dressing wounds was done by helpers
The Babylonia, 2000 B.C

 The people looked at diseases as being the result of sin
 The priests made their diagnoses and prognoses by observing various natural objects
such as behaviors or animals, flowing of water in rivers, pouring of oil on water surfaces
,personal dreams and when one become ill was counted to have bad moral behavior
The Indians, 1000 to 800 B.C

 The Indians had a highly developed culture and good sanitation
 During this time they had written a number of scientific books which described different
types of diseases
 The people who cared for the sick were well instructed in ethics
 They were required to be skillful, dedicated and prudent in both body and mind
The Jews
 The Jewish race had the finest record in hygiene and sanitation
 They had also a good knowledge of Anatomy and Physiology
The Greeks, 1200 B.C

 Many “Temple – hospitals” were built in memory of the god Aesculapius
 The usual method of deciding any particular treatment was that the patient, on entering
the hospital, prayed to the god Aesculapius
 Then the patient went to sleep and in his dreams the god Aesculapius himself would
reveal the drugs to be give
 The most famous centre of medicine was founded by Hippocrates, the “Father of Modern
Medicine”. He was born in 460 B.C. He discovered causes of disease and treat based on
the observed signs and symptoms

The Romans, 800 B.C.
 They were influenced by the Greek medicine
 The “Valetudinarians” were building in which the soldiers and slaves were treated and
cared for in order to increase manpower
 Galen, the anatomist lived in the 1st century
 His knowledge of anatomy and medicine became the foundation of modern medicine in
the 19th century
The, Christian Era, 50 A.D.

 The early Christians were inspired by the teaching of Christ
 Christ taught to help each other like brothers and sisters
 Service to the sick and the poor was service to God
 The bishops formed the religious orders of Deacons and Deaconesses
 Their duties were to attend the sick and the poor in their homes
 At this time nursing was regarded as a form of religious devotion
 Later hospices (house of the sick and the poor) were built by the monasteries
 The monks and nuns cared for the sick, the poor and the aged
 At the time of the CRUSADES in the 12th century, Military Orders were founded
 The most powerful and famous was the Order of the ”Knights Hospitallers of St. John of
Jerusalem” They founded hospitals in every country of Christendom
 In the 17th century the most important order was that of “Augustinian Sisters” in France
 The Sisters did nursing care as well as domestic work
 They lived a religious life and their work was directed by the priests and not the
physicians
 Later a French priest, Vincent de Paul, took interest in nursing
 He organized a group of country girls who had good character and trained them in giving
nursing care to the sick in hospitals and in homes
 From this group of girls he selected some and founded community of religious sisters
 This community was called “Sisters of charity” (or “sisters of Vincent de Paul”)
 Their prime function was to care for the sick
 Madam Le Gras developed an interest in Vincent de Paul’s work and decided to help him
She became the first Mother superior of this congregation
 The sisters were instructed to obey the physicians and to serve patients whole-heartedly
Vincent de Paul wanted the sisters to learn reading, writing and some arithmetic
The Dark Period of the Nursing, (18th Century.)

 Despite of new discoveries and great scientific development in medicine, the religious life
of the community was shallow
 Only a few people were ready to join religious Congregations and those who joined were
illiterate
 Napoleon, the emperor of France closed all the monasteries which catered for the sick and
used them for non-religious activities.
Development of Modern Nursing, (19thCentury)

Four types of organization developed gradually in order to improve the deteriorated care for
the sick
 The Catholic Religious Congregations
o When Napoleon realized the bad conditions in the hospitals, he permitted groups of
dedicated females to start religious congregations in order to care for the sick
o This call received good response and all over Europe new congregations grew up
o Among the prominent ones were the Sister of Charity (Vincent de Paul) and The
Sisters of Boromaeus
 Lutheran Deaconesses
o Stimulated by the catholic sisters, Theodor Fielder, a Lutheran pastor and his wife
established a hospital where women of good character were trained as deaconesses
o They cared for the sick and young children in both hospitals and homes
o They got practical instructions from the pastor’s wife, theoretical nursing lessons from
the physicians, and ethical lectures from the pastor
o These women had also to do some pastoral work
 Civil Orders Especially the Red Cross
o The Red Cross society was founded in Geneva in 1863 by a Swiss bank manager
called Henri Dunant
o Its goal has been and sill is to train nurses in times of peace in order to be able to care
for the wounded in times of war
o Many girls were trained and were organized into associations
o The “Red Cross Mother-house System were established in different countries
 Civil Nursing 1820 – 1910 Florence Nightingale
o Is the pioneer in Nursing Education
o In 1860 she founded the first nursing school at St. Thomas hospital, London
o By the middle of 18th century and the beginning of 19th century, nursing services
started to be delivered by civil nurses – women who did not belong to religious
congregations
o Florence Nightingale, an English lady, instituted the reforms in the care of the sick,
which form the basis as it is practiced now
o Florence Nightingale was born in Italy in 1820
o She was a well educated woman and belonged to a high social position
o In 1850 on a journey back to England from Egypt, she visited Kaiserwerth where she
stayed for two weeks
o In 1851 she paid a 3 months visit to pastor Fliedner’s Institute
o She was very much impressed by the organization of the deaconesses and their overall
goals of their organization but she found out the actual training of the nurses and
inadequate
o For this reason, she went to Paris in 1853 to have a better picture of the hospitals
which were run by the Sisters of Charity
o On her return to London, she supervised the “Establishment of Gentlewomen during
Illness”. This was some kind of nursing.
o In the meantime the Crimean War broke out
o The British, French and Turks were fighting against the Russians
o Sir Sidney, the Secretary of war, requested Florence Nightingale to take over the
Nursing care of the sick and wounded soldiers in Crimea because these soldiers were
neglected.
o Florence agreed and immediately went to Scutari city in Russia with 38 nurses. There
she found the hospitals were in a very poor state
o The wards were dirty, beds and patients infested with lice and bedbugs, the domestic
utensils were inadequate and laundry facilities were non-existent
o She worked very hard to improve the condition.
o After the Crimean War, she devoted her life to the re-organization of hospital services
and the training of civil nurses

o In 1860 she started the Nightingale School of Nursing at St. Thomas hospital in
London
o The money contributed by the British people enabled Florence Nightingale to start
this school.
o In 1859 Miss Nightingale published her first classical book titled “Notes on Nursing:
What it is ,and What it is not
o This book was used as the standard textbook at the Nursing school in St. Thomas
hospital
o She also defines nursing and state nurses’ pledge.
o Other important nurses in the development of the nursing profession include Mary
Escarole who also worked as a nurse in the Crimea; Elizabeth Jones and Linda
Richards who established quality nursing schools in USA and Japan and Linda
Richards who was officially America’s first professionally trained nurse, graduating
in 1873 from the New England Hospital for Women and Children in Boston

Handout 2.2: The Historical Background of Nursing in Tanzania
 In Tanzania traditional, the care of patients and women in child birth was carried out by
elder, married women in the community
 Western medicine was brought to Tanzania by then Tanganyika by the missionaries of the
different churches
 At the beginning the Africans preferred to trust their traditional midwives
 Therefore the missionaries sought for cooperation with these traditional midwives
 They taught them personal hygiene by using soap and water and also simple midwifery
techniques
 In 1893 the first hospital for Africans, Arabs and Asians was opened at Dar es Salaam.
 Slowly the idea of Western Medicine was accepted by the African, hence more hospitals
were built by the missionaries as well as by the Government
 At this time bedside nursing care was often given by male “dresser” who had some
primary education and by some illiterate married women who were called “Ayah”
 They were given some practical training and often turned out to very kind nurses
 The nursing administration was in the hands of expatriate doctors and nurses
 After the First World War the British took over the government from the Germans
 In 1919 the British started to organize the civil medical services
Nursing Training in Tanzania

 In 1925-African District Sanitary Inspectors were trained in Dar es Salaam, Tanga and
Tabora
 The training lasted three months
 Dispenser course was started
 The students were taught Anatomy, Physiology, Elementary Medicine, Minor Surgery
and Dental Practice
 Tribal Dresser was trained in a 3 months course at Kongwa and Dar es Salaam, they
studied Hygiene and the use of simple drugs
 In 1936 the course for Dispenser (later called Medical Assistants) extended to 3 years
 Candidates were required to possess Standard 10 education and the teaching was done in
English
 As young men and women had some education at the mission primary schools, were
trained to become nurses
 It was not difficult to obtain young men for the training, but there was strong opposition
to the idea of young women being allowed to attend child birth or to nurse male patient
 From 1930 to 1939 Several missions in Tanganyika took up the training of nurses
 Each hospital had its own scheme of training and syllabus and awarded its own certificate
Nursing affairs were dealt by the Medical Department of the Ministry of health
 At this time a Matron in Chief was appointed
 Most of the government hospitals were run by the British and other expatriate Nursing
Sisters
 The first group of Nurses received the government Nursing Certificate in 1943
 The candidates for these courses had minimal primary education who could write and
speak Swahili properly with little knowledge of spoken and written English

The progress in Nursing Education continued as follows
 In 1947 the first group of girls were trained as nurses by the government at Sewa Haji
Hospital in Dar es Salaam
 In 1948 this was milestone in the development of Nursing in Tanganyika
 From 1950 – 1960 Thirteen school for nursing training were existing
 The nursing schools run by the missions as well as government were: Mweka, Tanga
Princess Margareth in Dar es Salaam, Mvumi, Peramiho, Kiomboi, Magila, Ndolage,
Kolandoto, Mnero, Sumve and Kongwa
 In 1951 a new course with an annual intake of 12 students was established at Tukuyu to
train Health Nurses
 The course took two years, and included Midwifery, Child Care Nursing, Nutrition,
Hygiene, First Aid and domestic science
 On completion the Health Nurses were posted to Rural Maternity and Child Welfare
Clinics now known as Maternal and Child Health Clinics (MCH) where they worked
under the supervision of Health Visitor who were all foreigners
 Their main duties were the teaching of hygiene and nutrition at home, cleaning Child
Welfare Clinics, general health teaching and school health supervision
 Older women were preferred for the course as they had a greater influence in the villages
although they were not intended to act as midwives
 In addition to this course, Village Nurses were trained for 2 years at mission hospital, and
performed similar functions as the Health Nurse
 A limited number of “Practical or Village Midwives” were formally trained at District
Hospitals, so as to support the services of midwives in the rural areas
The Tanganyika Nurses and Midwives Council

 In the year 1952 the Tanganyika Nurses and Midwives Council was set up and enacted in
1953 by the act of Parliament as a “Statutory” body to govern the affairs of nurses. In
1997 the profession was regulated under the reviewed Tanzania Nurses and Midwives
Registration Act of 1997. Currently the profession is regulated through Tanzania Nursing
and Midwifery Act of 2010
 The Council members were Executive and Supervisory members
 In 1954 the standard of education for candidates was raised from standard IV to standard
VI1
 In 1956 the medium of instruction in nursing schools was changed from Swahili to
English except in the Health Nursing Training Schools at Tukuyu
 From 1957-1961 after the birth of TANU in 1954 most of the European Nurses including
Nurse and Nursing Officers in government hospitals, began to leave the country
 After the independence in 1961, there were few European nurses left
 This state of affair left a big gap especially on the administration side of the up-country
hospitals (Regional and District Hospitals)
 Some of the best Tanganyika nurses were sent overseas for training in England in order
to qualify as State Registered Nurses (SRN)
 On their return home they became Nursing Sisters, capable of running nursing services in
big hospitals such as Muhimbili
 In 1961a one year up-grading course was introduced by the Ministry of Health for
registered nurses and midwives
 The course consisted of practical nursing administration with a final oral examination
 Several nurses graduated and were immediately promoted to Nursing Sisters (Females)
and Charge Nurses (Males) in order to replace the expatriate sisters who left the country
 In December 1963 this course was discontinued
 In 1962 the Health Nurse Training Schools at Tanga and Tukuyu were discontinued
 A new nursing syllabus was introduced, where by public health, midwifery and general
nursing were integrated for the purpose to prepare an “all purpose nurse” who could
work in a general hospital, maternity ward or clinic
 It was also called “Multipurpose Training”. However, this was found to be insufficient
and was discontinued in 1969
 In 1964 a 1-year up-grading course in a new format was introduced.
 The candidates were of 2 types;
 Grade ‘B’ nurses who had completed 3 years nursing programme from Muhimbili and
other schools
 Grade ‘B’ Nurses who had worked for not less than 3 years and have passed the entrance
examination
 The course consisted of general nursing and midwifery for females and psychiatry for
males
 Upon successful completion of the course they were registered as grade ‘A’ Nurses and
used the title of a Staff Nurse
 In 1965, four Tanzanian Nursing Officers, The late Miss E.E Zablon and Miss J.
Kimangano, Miss S. Wendeline and Mr. B. Komba were sent to Australia to take Tutor’s
Diploma Course
 In 1966 a new syllabus was prepared which reverted to the old system of separate courses
for General Nursing which lasted 3 years and Midwifery one year, designed for primary
school leavers
 From 1961 more standard 10 leavers were admitted at Muhimbili
 In 1963 many were standard 12 school leavers left the course and took up other courses –
either joining other professions or to continue with higher education
 Muhimbili continued to take standard 12 leavers for the nursing course
 During this period, a special 4 years integrated nursing course was introduced for form IV
school leavers
 This course integrated General Nursing, Administration and Teaching, Community
Nursing and Midwifery for females, psychiatry for male students
 Passed candidate were registered as staff nurse part1, section A
 They were also eligible for registration in some outside commonwealth countries, such as
England and Wales as State Registered Nurse (S.R.N)
 In 1970 the duration of up-grading course changed from one year to one and a half year.
 In 1971 a second Integrated school of nursing for form IV leavers started at Bugando
hospital, Mwanza
 In 1972 a third Integrated school of nursing for form IV leavers started at Kilimanjaro
Christian Medical Centre (KCMC), Moshi
 In 1970 the old government school of nursing at Bombo hospital, Tanga was re opened.
This time, instead of training pre-service students, it enrolled in-service nursing assistants
to be trained as grade “B’ nurses
 The school continued to train nurses until 1976 when it started to train midwives as well.
 In 1980 Mkomaindo School of Nursing was changed from a pre-service to in-service
school for Nursing Assistants

Midwifery Training
 In 1937 the first intake of students’ for midwifery training started at Tanga
 In 1945 Lulindi stated to train midwives
 In 1946 Magila started to train midwives
 In 1947 Mvumi started to train midwives
 In 1950 there were altogether 8 schools training midwives
 They were Tanga, Lulindi, Magila, Sumve, Peramiho and Muhimbili, Dar es Salaam, at
the famous “Makuti” area, where all building were thatched by “Makuti” (coconut leaves)
 In 1952 Ndanda started a 2 year midwifery course
 From 1960-1970 four new midwifery schools were opened at Kilimatinde,
 Makiungu, Ndolage and Sengerema making a total of 13 midwifery schools in the county
 Most schools train both nurses and midwives except Kabanga and Dareda, while Newala
and Makiungu train Midwives only
Maternal and Child Health Aide (MCHA) Training

 In 1975 with the aid of the United States of America, 18 MCHA schools were established
 The 19th school at Murugwanza in Ngara district, Kagera Region, was late to start
 The candidates for this course were girls who had completed primary school education
and have had a one year working experience as a Nursing or ward attendant the training
lasted for one year
 After completing the course they were sent to work in MCH clinics in rural areas
 This continued up to 1977
 In 1978 the ward attendants ceased to be candidates for the course
 Young girls who have completed primary school were selected from the villages and
were trained for one and a half year
 In 1980 the duration of the course was extended to 2 years
 The cadre of village – midwives ceased from the scheme of service of civil servants
 This village – midwives were obliged to undergo a MCHA course for 9 months in order
to be employed as Maternal and Child Health Aides (MCHA)
 This programme was conducted at Kondoa, Tarime and Kibondo
 Upon qualification MCH Aides are awarded a certificate by the Ministry of Health but
they are not registered by the Tanganyika Nurses and Midwives Council.
 In 1982 an up-grading course for MCH Aides was started at Bagamoyo and Korogwe
Upon successful completion of the course they become Public health Nurses ‘B’ and are
eligible for registration in the Register of the Tanganyika and Midwives Council
 The course tooks 2 years
Up - Grading Courses
 In 1970 the up-grading programme changed
 This time it was for grade ‘B’ nurses with a minimum working experience of 3 – 4 years
 The course lasted for one and a half year
 After completion of the course they used the title of “Staff Nurse
 Their salary scale was the same as those who completed the Integrated 4-year nursing
course.
 In 1973 a one-year psychiatric nursing course was established at Mirembe hospital,
Dodoma, as an up-grading course for section ‘B’ nurses
 In 1980 the course’s duration was extended to one and a half years and the graduated
were registered as section ‘A’ Psychiatric Staff Nurse

 Those nurses who took the course for one year only were recalled to complete the 6
months so that they may be registered in section ‘A’
 These psychiatric staff nurses were posted to different psychiatric units in regional
hospitals and consultant hospitals
 In 1976 a Public Health Nursing Course was established at Muhimbili hospital
 The primary objective to establish this course was to get Public Health Nurses who would
strengthen the MCH services in the country and supervise MCH Aides
 Later some of the best public health Nurses were appointed as principals and teachers in
MCH Schools
 With the increasing demand for public Health Nurses, a second school was opened at
Morogoro (the former MCHA school) to make a total output of 72 Public Health Nurses
every 2 years
 This course was entirely for female nurses
 In 1978 Ophthalmic Nursing Course was established at Kilimanjaro Christian Medical
Centre, Moshi
 The number of intake is 26 students every 2 years
 In 1980 a Pediatric Nursing Course was established at Kilimanjaro Christian Medical
Centre with an intake of 26 students every 2 years.
 In 1986 Operating Theatre Management Course was established at Mbeya Referral
Hospital
 The number of intake is 12 every 2 years.
Nurse Teachers Diploma Course

 In 1973 the Dar es Salaam Nurse Teachers College was established with the aid of World
health Organization
 The College conducted a one year Diploma in Nursing Education Course
 The candidates for this course were Staff Nurses with a working experience of at least 2
year
 In 1979 the course was extended from 12 months to 18 months
 By 1989 a total of a195 nurse-teachers qualified from this college
 They are now teaching in both government and voluntary agency schools of nursing
 In 1989 the course started to be conducted by the University of Dar es Salaam for 2
academic years offering an Advance Diploma in Nursing Education
Bachelor of Science Degree and Masters Degree in Nursing

 In 1989 Bachelor of Science Degree in Nursing started at the University of Dar es Salaam
 The course is conducted at the Faculty of Medicine, Muhimbili Medical Centre
Candidates eligible for the course are:
o Pre-service candidates, Form VI leavers with good passes in science subjects
o The duration of the course is 4 academic years
o From 1992 Mature entry programme was introduced
o The candidates are categorized as follows:
 Nurses with Diploma in Nursing Education will undergo this programme for 2
years
 In 1998 Bachelor of Science degree in Nursing at Hubert Khairuki Memorial University
 From 2002 to 2009 courses on bachelor of Science in Nursing increased at Agha-Khan
University, Tumaini University, IMTU, Dodoma and St John’s University
 In 2007, masters degree in nursing were established at Muhimbili University, School of
Nursing

Session 3: Models and Theories Used in Nursing
Prerequisite:
 None
Learning Tasks
 Define models, theories and nursing theory
 Describe elements of nursing theory
 Explain selected theories in nursing practice
Resources Needed
SESSION OVERVIEW
Steps Time Activities/Method Content

Presentation of Session Title and Learning
1 5 minutes Presentation
Tasks
Presentation/ Definition of Models, Theories and Nursing
2 15 minutes
Group discussion Theory
Elements of Nursing Theory
Presentation Describe selected Theories in Nursing

4 70 minutes Practice
SESSION CONTENTS

READ or ASK Students to read Learning tasks
ASK Students if they have any question before continuing

NTA Level 4, Semester 1 23 Session 3: Models and Theories Used in
Nursing
Step 2: Definitions of Terms Models, Theories and Nursing Theory
(15 minutes)
Activity: Buzzing (5 minutes)
TELL the students to pair up and buzz on the term theory, model and nursing theory
ALLOW few students to give their responses and the rest to provide unmentioned
responses
CLARIFY and summarize utilizing information below
 Theory is an assumption or supposition based on certain evidences or observations but

lacking scientific proof: When proved and agreed it becomes a principle
 Model means something which a copy can be based on because it is an extremely good
example of its type.
 Nursing Theory are theoretical framework that provide a reason and purpose for nursing
actions that helps a nurse to systematically develop problem solving skills
Step 3: Elements of Nursing Theory (10 minutes)

Person
 Recipient of care, including physical, spiritual, psychological, and sociocultural
components.
 Individual, family, or community.
 Environment: All internal and external conditions, circumstances, and influences
affecting the person.
Health: Degree of wellness or illness experienced by the person
Nursing: Actions, characteristics and attributes of person giving care
Step 4: Theories in Nursing Practice (70 minutes)

Introduction
 Nursing is practiced based on theories.
 Nursing theories must applied in provision of health care. The following are some
nursing theories
o Florence Nightingale theory
o Orem’s theory of self care
o Roy’s adaptation theory
o Imogene King’s goal attainment theory
o Virginia Henderson- Need theory
o Faye Glenn Abdellah's Theory
Florence nightingale theory

 Born - 12 May 1820
 Founder of modern nursing.
 The first nursing theorist.
 Also known as "The Lady with the Lamp"
 International Nurses Day, May 12 is observed in respect to her contribution to Nursing.
 Died - 13 August 1910
Nursing
Assumptions of Nightingale’s Theory
 Nursing is a calling
 Nursing is an art and a science
 Nursing is achieved through environmental alteration
 Nursing is distinct and separate from medicine
Nightingale’s Canons: Major Concepts

 Ventilation and warming
 Light, Noise
 Cleanliness of rooms/walls
 Health of houses
 Bed and bedding
 Personal cleanliness
 Variety
 Chattering hopes and advices
 Taking food. What food?
 Petty management/observation
Theory elements
Nursing
 Nursing is different from medicine and the goal of nursing is to place the patient in the
best possible condition for nature to act.
 Nursing is the "activities that promote health (as outlined in canons) which occur in any
care giving situation. They can be done by anyone."
Person
 People are multidimensional, composed of biological, psychological, social and spiritual
components.
Health
 Health is “not only to be well, but to be able to use well every power we have”.
 Disease is considered as disease or the absence of comfort.
Environment
 "Poor or difficult environments led to poor health and disease".
 "Environment could be altered to improve conditions so that the natural laws would allow
healing to occur."
Nightingale’s Theory and Nursing Practice

Application of Nightingale's theory in practice:
 "Patients are to be put in the best condition for nature to act on them; it is the
responsibility of nurses to reduce noise, to relieve patients’ anxieties, and to help them
sleep."
 As per most of the nursing theories, environmental adaptation remains the basis of
holistic nursing care.
Orem’s theory of self care

 Theorist : Dorothea Orem (1914-2007)
 Theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in
1995, and 2001.

Nursing
Major assumptions
 People should be self-reliant and responsible for their own care and others in their family
needing care
 Nursing is a form of action – interaction between two or more persons
 A person’s knowledge of potential health problems is necessary for promoting self-care
behaviors
Orem’s general theory of nursing in three related parts:
 Theory of self care
 Theory of self care deficit
 Theory of nursing system
Theory of Self Care

This theory includes:
 Self-care – practice of activities that individual initiates and perform on their own behalf
in maintaining life ,health and well being
 Self-care agency – is a human ability which is "the ability for engaging in self-care" -
conditioned by age developmental state, life experience sociocultural orientation health
and available resources
 Therapeutic self-care demand – "totality of self-care actions to be performed for some
duration in order to meet self-care requisites by using valid methods and related sets of
operations and actions"
 Self-care requisites - action directed towards provision of self-care. There are three
categories of self-care requisites which are-
o Universal self-care requisites: Associated with life processes and the maintenance of
the integrity of human structure and functioning. These requisites are: Maintenance
of sufficient intake of air ,water, food
o Developmental self-care requisites; Associated with developmental processes, E.g.
adjusting to a new job and adjusting to body changes
o Health deviation self-care requisites; Required in conditions of illness, injury, or
disease; these include: Seeking and securing appropriate medical assistance and
learning to live with effects of pathologic conditions
Theory of self-care deficit
 Specifies when nursing is needed
 Nursing is required when an adult (or in the case of a dependent, the parent) is incapable
or limited in the provision of continuous effective self-care. Orem identifies 5 methods of
helping:
o Acting for and doing for others
o Guiding others
o Supporting another
o Providing an environment promoting personal development in relation to meet future
demands
o Teaching another
Theory of Nursing Systems

 Describes how the patient’s self care needs will be met by the nurse , the patient, or both
 Identifies 3 classifications of nursing system to meet the self care requisites of the
patient:-
o Wholly compensatory system
o Partly compensatory system
o Supportive – educative system

Nursing
Theory elements
Nursing
 Actions deliberately selected and performed by nurses to help individuals or groups under
their care to maintain or change conditions in themselves or their environments
 Goal of nursing – to render the patient or members of his family capable of meeting the
patient’s self care need
Health
 It is when they are structurally and functionally whole or sound
Environment
 environment components are enthronement factors, enthronement elements, conditions,
and developed environment
Human being
 Conceptualized as a total being with universal, developmental needs and capable of
continuous self care
 A unity that can function biologically, symbolically and socially
Roy’s adaptation theory

 Sr.Callista Roy- nurse theorist
 Born at Los Angeles on October 14, 1939.
Assumptions
 The person is a bio-psycho-social being.
 The person is in constant interaction with a changing environment.
 To respond positively to environmental changes, the person must adapt.
 The person has 4 modes of adaptation: physiologic needs, self- concept, role function and
inter-dependence.
Major Concepts
 Adaptation -- goal of nursing
 Person -- adaptive system
 Environment -- stimuli
 Health -- outcome of adaptation
 Nursing- promoting adaptation and health
Person
 Bio-psycho-social being in constant interaction with a changing environment
 Includes people as individuals or in groups-families, organizations, communities, and
society as a whole.
Environment
 Focal - internal or external and immediately confronting the person
 Contextual- all stimuli present in the situation that contribute to effect of focal stimulus
 Residual-a factor whose effects in the current situation are unclear
 All conditions, circumstances, and influences surrounding and affecting the development
and behavior of persons and groups with particular consideration of mutuality of person
and earth resources, including focal, contextual and residual stimuli

Nursing
Health
 A state and a process of being and becoming integrated and whole
Nursing
 To promote adaptation in the four adaptive modes
 To promote adaptation for individuals and groups in the four adaptive modes, thus
contributing to health, quality of life, and dying with dignity by assessing behaviors and
factors that influence adaptive abilities and by intervening to enhance environmental
Implication to nursing practice

 Nursing practice is directed towards promoting individual or group adaptation
 Roy adaptations model nursing process encompasses the following steps
o Assessment of behavior
 This is the systematic gathering data about the behavior of the human adaptive
system and judge the current state of adaptation.
o Assessment of stimuli: This involve identification of internal and external focal and
contextual stimuli that are influencing the behavior of particular interest
o Nursing diagnosis
 This involves the process of judgment to make a statement conveying the
adaptation status of the human adaptive system of interest. It is a statement that
identifies the behavior of interest together with the most relevant influencing
stimuli
o Goal setting
 These are clear statement of the behavior outcomes in response to nursing
provided to the human adaptive system. The goals may be specific, short term and
long term behavior outcomes
o Nursing interventions
 It includes selection and implementation of nursing interventions that have high
probability of changing stimuli or strengthening adaptive process. The nurse
manages the focal stimulus first if possible, and then manages the contextual
stimuli
o Evaluation
 This involves judgment of the effectiveness of nursing interventions in relation to
the behaviors of the human adaptive system
Imogene King’s theory of goal attainment self

 Theorist: Imogene King - born in 1923.
 Theory describes a dynamic, interpersonal relationship in which a person grows and
develops to attain certain life goals.
 Factors which affects the attainment of goal are: roles, stress, space & time
Basic assumptions
 Basic assumption of goal attainment theory is that nurse and client communicate
information, set goal mutually and then act to attain those goals, is also the basic
assumption of nursing process
 “Each human being perceives the world as a total person in making transactions with
individuals and things in environment”
 “Transaction represents a life situation in which perceiver & thing perceived are
encountered and in which person enters the situation as an active participant and each is
changed in the process of these experiences”
Nursing
Major Concepts
 Interacting systems:
o personal system
o Interpersonal system
o Social system
 Concepts are given for each system
Concepts for Personal System

 Perception
 Self
 Growth & development
 Body image
 Space
 Time
Concepts for Interpersonal System

 Interaction
 Communication
 Transaction
 Role
 Stress
Concepts for Social System

 Organization
 Authority
 Power
 Status
 Decision making
Nursing Elements
Person
 Refers to social being who are rational and sentient, has ability to perceive, think, feel,
choose, set goals, select means to achieve goals and to make decision
 Has three fundamental needs:
o The need for the health information that is unable at the time when it is needed and
can be used
o The need for care that seek to prevent illness, and
o The need for care when human beings are unable to help themselves.
Health
 Health involves dynamic life experiences of a human being, which implies continuous
adjustment to stressors in the internal and external environment through optimum use of
one’s resources to achieve maximum potential for daily living.
Environment
 Environment is the background for human interactions it involves:
o Internal environment: transforms energy to enable person to adjust to continuous
external environmental changes.
o External environment: involves formal and informal organizations. Nurse is a part of
the patient’s environment.

Nursing
Nursing
 Definition: “A process of action, reaction and interaction by which nurse and client share
information about their perception in nursing situation.” and “ a process of human
interactions between nurse and client whereby each perceives the other and the situation,
and through communication, they set goals, explore means, and agree on means to
achieve goals.”
 Goal of nurse: “To help individuals to maintain their health so they can function in their
roles.”
Implication to nursing Practice

 King’s theory helps individual to maintain their health so that they can function in their
roles.
 This is achieved through a process of assessment, diagnosis, planning, implementation
and evaluation maintain values and the mechanism to regulate the practices and role
Virginia Henderson-Need theory

 “The Nightingale of Modern Nursing”
 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."
 Born in Kansas City, Missouri, in 1897.
 Died: March 19, 1996.
 Her definition of nursing was:
"The unique function of the nurse is to assist the individual, sick or well, in the performance
of those activities contributing to health or its recovery (or to peaceful death) that he would
perform unaided if he had the necessary strength, will or knowledge, and to do this in such a
way as to help him gain independence as rapidly as possible" (Henderson, 1966).
The 14 components
 Breathe normally.
 Eat and drink adequately.
 Eliminate body wastes.
 Move and maintain desirable postures.
 Sleep and rest.
 Select suitable clothes-dress and undress.
 Maintain body temperature within normal range by adjusting clothing and modifying
environment
 Keep the body clean and well groomed and protect the integument
 Avoid dangers in the environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fears, or opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of accomplishment.
 Play or participate in various forms of recreation.
 Learn, discover, or satisfy the curiosity that leads to normal development and health and
use the available health facilities.
The first 9 components are physiological. The tenth and fourteenth are psychological aspects
of communicating and learning, the eleventh component is spiritual and moral. The twelfth
and thirteenth components are sociologically oriented to occupation and recreation

Nursing
Assumption
The major assumptions of the theory are:
 "Nurses care for patients until patient can care for themselves once again.
 Patients desire to return to health.
 Nurses are willing to serve and that “nurses will devote themselves to the patient day and
night”
Theory elements
 Person
o Have basic needs that are component of health.
o Requiring assistance to achieve health and independence or a peaceful death.
o Considers the biological, psychological, sociological, and spiritual components.
 Environment
o Settings in which an individual learns unique pattern for living.
o All external conditions and influences that affect life and development.
 Health
o Definition based on individual’s ability to function independently as outlined in the 14
components.
o Is the individual’s ability to meet these needs independently.
o Good health is a challenge -affected by age, cultural background, physical, and
intellectual capacities, and emotional balance
 Nursing
o Temporarily assisting an individual who lacks the necessary strength, will and
knowledge to satisfy 1 or more of 14 basic needs.
o Nurse serves to make patient “complete” “whole", or "independent."
o The nurse is expected to carry out physician’s therapeutic plan Individualized care is
the result of the nurse’s creativity in planning for care.
 Implications to nursing practice: The nurse requires knowing and understanding
patients by putting themselves in the place of the patients. Basic nursing care involves
helping the patient perform the fourteen basic needs unaided;-
Faye Glenn Abdellah's Theory

 Birth:1919
 Abdellah’s patient - centred approach to nursing was developed inductively from her practice
and is considered a human needs theory.
 Although it was intended to guide care of those in the hospital, it also has relevance for nursing
care in community settings.
 "Nursing is based on an art and science that mould the attitudes, intellectual competencies,
and technical skills of the individual nurse into the desire and ability to help people, sick or
well, cope with their health needs." – Abdellah explained nursing as a comprehensive service,
which includes:
o Recognizing the nursing problems of the patient
o Deciding the appropriate course of action to take in terms of relevant nursing principles
o Providing continuous care to relieve pain and discomfort and provide immediate security
for the individual
o Adjusting the total nursing care plan to meet the patient’s individual needs
o Helping the individual to become more self directing in attaining or maintaining a healthy
state of mind & body
o Instructing nursing personnel and family to help the individual do for himself that which
he can within his limitations

Nursing
o Helping the individual to adjust to his limitations and emotional problems
o Working with allied health professions in planning for optimum health on local, state,
national and international levels
o Carrying out continuous evaluation and research to improve nursing techniques and to
develop new techniques to meet the health needs of people
Assumptions were related to

 Change and anticipated changes that affect nursing;
 The need to appreciate the interconnectedness of social enterprises and social problems;
 The impact of problems such as poverty, racism, pollution, education, and so forth on health
care delivery;
 Changing nursing education
 Continuing education for professional nurses
 Development of nursing leaders from under reserved groups
 Abdellah and colleagues developed 10 steps to identify the client’s problems, developed 11
nursing skills to be used in developing a treatment typology and they also developed list of
21 nursing problems. 10 steps to identify the client’s problems are;
o Learn to know the patient
o Sort out relevant and significant data
o Make generalizations about available data in relation to similar nursing problems
presented by other patients
o Identify the therapeutic plan
o Test generalizations with the patient and make additional generalizations
o Validate the patient’s conclusions about his nursing problems
o Continue to observe and evaluate the patient over a period of time to identify any attitudes
and clues affecting his behavior
o Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the
plan
o Identify how the nurses feels about the patient’s nursing problems
o Discuss and develop a comprehensive nursing care plan
 11 nursing skills
o Observation of health status
o Skills of communication
o Application of knowledge
o Teaching of patients and families
o Planning and organization of work
o Use of resource materials
o Use of personnel resources
o Problem-solving
o Direction of work of others
o Therapeutic use of the self
o Nursing procedure
21 nursing problems
 Three major categories
o Physical, sociological, and emotional needs of clients
o Types of interpersonal relationships between the nurse and patient
o Common elements of client care

Nursing
Basic to all patients
 To maintain good hygiene and physical comfort
 To promote optimal activity: exercise, rest and sleep
 To promote safety through the prevention of accidents, injury, or other trauma and through
the prevention of the spread of infection
 To maintain good body mechanics and prevent and correct deformity
Sustenal care needs

 To facilitate the maintenance of a supply of oxygen to all body cells
 To facilitate the maintenance of nutrition of all body cells
 To facilitate the maintenance of elimination
 To facilitate the maintenance of fluid and electrolyte balance
 To recognize the physiological responses of the body to disease conditions
 To facilitate the maintenance of regulatory mechanisms and functions
 To facilitate the maintenance of sensory function.
Remedial care needs

 To identify and accept positive and negative expressions, feelings, and reactions
 To identify and accept the interrelatedness of emotions and organic illness
 To facilitate the maintenance of effective verbal and non verbal communication
 To promote the development of productive interpersonal relationships
 To facilitate progress toward achievement of personal spiritual goals
 To create and / or maintain a therapeutic environment
 To facilitate awareness of self as an individual with varying physical , emotional, and
developmental needs
Restorative care needs

 To accept the optimum possible goals in the light of limitations, physical and emotional
 To use community resources as an aid in resolving problems arising from illness
 To understand the role of social problems as influencing factors in the case of illness
Abdellah’s theory and the four major concepts

Nursing
 Nursing is a helping profession.
 Nursing care is doing something to or for the person or providing information to the person
with the goals of meeting needs, increasing or restoring self-help ability, or alleviating
impairment.
 Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing
judgment.
Person
 Abdellah describes people as having physical, emotional, and sociological needs.
 Patient is described as the only justification for the existence of nursing.
 Individuals (and families) are the recipients of nursing
Health
 In Patient–Centered Approaches to Nursing, Abdellah describes health as a state mutually
exclusive of illness.

Nursing
Society and environment
 Society is included in “planning for optimum health on local, state, national, and international
levels”. However, as she further delineated her ideas, the focus of nursing service is clearly
the individual.
 The environment is the home or community from which patient comes.
Step 5: Key Points (10 minutes)
 Eleven Nursing skills

o Observation of health status
o Skills of communication
o Application of knowledge
o Teaching of patients and families
o Planning and organization of work
o Use of resource materials
o Use of personnel resources
o Problem-solving
o Direction of work of others
o Therapeutic use of the self
o Nursing procedure
Step 6: Evaluation (10 minutes)
 Define the following terms theory, model and nursing theory

 What are the selected theories in nursing practice

Nursing
References
Alexander, M. F., Fawcett, J. N., & Runciman, P. J. (2002). Nursing practice (2nd ed.).
London: Churchill Livingstone.
Bewes, P. (2003). Surgery: A manual for rural health workers (2nd ed.). Nairobi: AMREF.
Black, J. M., & Hawks, J. H. (2009). Medical surgical nursing (8th ed.). Philadelphia: W. B.
Saunders.
Bloom, A., & Bloom, S. (1994). Toohey’s medicine: A textbook for students in the health
care professions (15th ed.). London: Churchill Livingstone.
Brigden, R. J. (1998). Operating theatres technique (5th ed.). London: Churchill Livingstone.
Brunner, L. S., & Suddath, S. D. (1999). Medical surgical nursing (9th ed.). Philadelphia:
Lippincott.
Colmer, M. R. (2005). Moroney’s surgery for nurses (16th ed.). London: Churchill
Livingstone.
Dixon, E. (1983). Theatre technique (5th ed.). London: Bailliere Tindall.
Ignatavius, D. D., & Workman, M. L. (1995). Medical surgical nursing. Philadelphia: W. B.
Saunder.
Hinchliff, S. (1996). Dictionary of nursing (17th ed.). London: Churchill Livingstone.
Lewis, S. M., & Collier, I. C. (1998). Medical surgical nursing assessment and management
of clinical problems. New York: Mosby.
Long, B. C., Phipps, W. J., & Cassmeyer, V. (1993). Medical surgical nursing: A nursing
process approach. London: Mosby.
MOHSW. (2005). National guidelines for the clinical management of HIV/AIDS. Tanzania:
MOHSW.
Monahan, F. D., & Sands, J. K., Neighbors, M., Marek, J. F., & Green, C. J. (2007). Medical
surgical nursing: Health and illness perspective (8th ed.). Canada: Mosby Elsevier.
Nursing Theories. (2012). Nursing theory. Retrieved from http://www.currentnursing.com
Peattie, I. P., & Walker, S. (1995). Understanding nursing care (4th ed.). St. Louis: Churchill
Livingstone.
Watson, J. E. (1997). Medical surgical nursing and related physiology. London: Saunders.
Wilson, M. (1993). Surgical nursing (11th ed.). London: ELBS.

Nursing
Session 4: Tanzania Nursing Practice Model
Prerequisite
 Nursing Theories
Learning Tasks
 By the end of this session, students are expected to be able to:
 Define concept and Conceptual model
 Describe application of Tanzania nursing model in provision of quality nursing care
Resources Needed
 Overhead Projector
SESSION OVERVIEW
Step Time Activities/Method Content

Presentation/ Common Terms Used in Tanzania Nursing
2 15 minutes
Group discussion Practice Model
Mission, Vision and Philosophy of The Tanzania
Nursing Practice Model
Rationale and Objectives for Developing the
Model
Model, Components and Application of Core
Concepts
SESSION CONTENTS

READ or ASK Students to read Students’ learning tasks
ASK Students if they have any question before continuing

NTA Level 4, Semester 1 36
Step: 2 Definitions of Concept and Conceptual Model (15 minutes)
TELL the students to pair up and define the term concept and conceptual framework (5
minutes)
ALLOW few students to give their responses and the rest to provide unmentioned
responses
CLARIFY and summarize utilizing information below
Introduction
 As a practice discipline and profession, nursing is often described as both an “art” and a
“science”.
 The art of practice is grounded in scientific principles.
 The science and practice of nursing are recognized as the profession’s two major
dimension
 Without nursing science, nursing practice could not exist.
 Conceptual and theoretical nursing models generate knowledge that will improve nursing
practice, guide Nursing research, and facilitate the organization of the curricula of all
levels of nursing education.
Definitions
 Concept: Idea of a class of objects, a consciousness of particular qualities that make an
object or idea it is or appears to be.
 Conceptual Framework or Conceptual Model: Is a set of concepts and the prepositions
that integrate them into meaningful configuration.
o Conceptual model can be modified with changes of the time, education.
Step 3: The Mission, Vision and Philosophy of the Tanzania Nursing Model
(20 minutes)
 Vision: a viable strong profession with nurses who are autonomous in the delivery of
high quality and cost-effective healthcare to the community.
 Mission: Nursing is a profession that is committed to the provision of high quality
nursing care to individuals, families and communities to contribute to their quality of life.
 Philosophy: All nursing professionals will be bound by a core of shared values and
believe that:
o All clients have the right to receive effective nursing care.
o This care is personal service that is based on client’s needs and their health condition.
o The obligation of nursing is to help, promote health, prevent disease and rehabilitate
to best possible state of health, we pledge intelligent cooperation in coordinating
nursing services with other health and health related professionals
o Understanding the importance of research and teaching for improving health care, the
nursing profession will be supported, promote and participate in these activities.
o Using knowledge of human behavior we shall strive to provide an atmosphere for the
developing the fullest possible potential of each member of the nursing profession.

o We believe that nursing personnel are individual accountable to clients and their
families for the quality and compassionate caring for upholding the standards of care
as agreed by the professional body.
Step 4: Rationale and Objectives for Developing the Tanzania Nursing

Practice Model (15 minutes)
 Models provide nurse with a way to understand people and their needs, and indicate the
area of practice in which nursing is distinct from other disciplines of health care.
 Rationale for Developing the Model
o The model was developed to:
 Provide for uniform framework for thinking and practice.
 Provide for integration of socio-cultural aspects in practice.
 Give provision for enhancing professional autonomy.
 Provide for a framework that considers an individual as a whole being.
 Provide for professional performance at international standards.
 Objectives of the Model
o To develop mechanisms, approaches and schemes foe strengthening nurse's
competence, collaboration, respect and compassion.
o To establish a system of helping nurses in Tanzania to organize their thinking about
nursing and design their practice in an orderly way and logical way.
o To facilitate and empower nurses to take strong interest and have strong voice in
leadership, professionalism, education, Standards of care, nursing care systems and
research.
o To generate experience for nurses in handling challenges and opportunities by
critical thinking, reflection and creativity.
o To establish a system to test and monitor the extent to which the model can give
evidence for nursing practice outcome.
Step 5: The Model, Core Concepts, Components and Application

(50 minutes)
 Model and its Components

o At the Centre of the model are the client, the nurse, the family and the community
whose interactions are directed towards mutual goal setting and implementation
o In meeting the set goals; competence, compassion, collaboration and respect are
essential.
o Inherent in the model are components important to professionalism, education and the
nursing care delivery system.
o The model is process oriented. Mutual goal setting: (results aimed at) this involves the
nurse, the client and significant others agreeing on needs and problems, ways of solving
them and expected outcomes of care.
o Goals should be clearly set and written in a way that shows a clear indication of
standards of care being sought.
o The client: is any person who seeks help or advice from a professional person.
 In health care system, a client is perceived as a well person or sick person.
 This perception can be extended to include family and a community.
 To achieve mutual goal setting the client has the right to be involved in making
informed choices about him/her.

o The nurse (completed and approved nursing programme by the council registered or
enrolled authorized to render services)
 The nurse is expected to demonstrate the attribute of competence, compassion,
respect and collaboration
 The nurse is patient’s advocate.
 The nurse is expected to use effective communication with the clients and co-
workers.
o The family is a social group whose members share common values, occupy specific
positions and interact with each other over a time.
 Family may include all significant others to the client.
 Family members share responsibility with each other for the functional health of all
members.
 Family members share responsibility with each other for the functional health of all
members.
 In the model family members are part and parcel of the mutual goal setting process
for the clients who can actively participate and those who cannot.
 Application of Core Concepts

o Competence
 The nurse must be competent in practice, apply knowledge and skills in
assessment, observation, communication and judgment in proving quality care.
 Consider safety of patients/clients
 Acknowledges limitations in their knowledge and competence.
 Practice ethically by striving for the best care achievable.
 Strive to improve professional knowledge and competences.
 Utilize current knowledge and technology in providing care.
o Compassion
 The nurse should be;
 Active in listening, and patience.
 Show concern for the total person; be sensitive to the client needs by responding
in a professional manner.
 Be always available and provide care with respect for human dignity.
o Collaboration
 The nurse should;
 collaborate with others for effective action
 Work in team to make most effective use of various types of personnel
 Team work provides the most effective care through joint decision.
 Components important to professional practice

o The nursing care delivery system:
 The philosophy of nursing delivery is “Holistic Care to Clients” provided by
competent nurse.
 Professionalism nurses are committed to evolution of a fairly distinct body of
knowledge that separates nursing from other professions.
 Nurses should abide to the professional code of conduct and ethics in Tanzania.
 The profession will adhere to practice

 Nursing standard
o Is the descriptive statement of desired quality against which to evaluate nursing care
o Follow set standards in line with the context but be reviewed periodically to meet the
needs of changing environment. Nursing standards set according to research evidence
o Research: nurses should do research or participate; and share research findings
through publications.
o Leadership: is the ability to influence others to strive for a vision or goal or to change.
 Nurses should be able to utilize the leadership skills in the process of planning,
organizing, directing and controlling to improve the quality of care.
o Education: essential to nursing practice (knowledge base and clinical skills).
o Integration of socio-cultural issues: in family and community, there are many beliefs
and values that prevail among individuals, families and groups that have not surfaced
and integrated into practice.
 These socio-cultural affect health behavior and compliance.
 The nurse therefore should be aware of socio-cultural issues related to clients.
 Agree on meanings of beliefs, values and practices with the client and family.
 Negotiate with the client and the family on the meanings in order to enhance those
that are useful and those that are harmful to be rejected.
o Creating and maintaining nurse –patient relationship: establish a good personal and
patient relationship whereby each perceives the other and the situation.
o Use nursing process: the model will guide the way in which the process of nursing is
put into action.
 Each step of the nursing process is carried out is influenced by the model on
which practice is based.
o Communicating effectively: observe verbal and non-verbal communication.
 Effective communication is possible when there is openness and transparency.
 Communication must be two way process.
 Outcome may be
 Primary outcome
 client satisfaction,
 physical, psychological and spiritual recovery,
 client attracted to use the services,
 reduced patient stay in hospital,
 Willingness of consumer relationship in an organization (patients, care providers).
 Nurse’s satisfaction
 Improved quality of professional relationships
o Strategic outcome
 improved health service delivery
 conducive working environment
 increased support for personal and profession development
 system’s ability to respond flexibly to dynamic changes
 ability of nurses to influence health care direction
 Increased image of nursing through education and research.

 Conceptual and theoretical nursing models generate knowledge that will improve nursing
practice
 Conceptual framework or model: is a set of concepts and the prepositions that integrate
them into meaningful configuration.
o A tool through which ideas, knowledge, concepts and values about nursing could be
processed into a printed graphical format, suitable for quick comprehension and
application.
 The model was developed to:
o Provide for uniform framework for thinking and practice.
o Provide for integration of socio-cultural aspects in practice.
o Give provision for enhancing professional autonomy.
o Provide for a framework that considers an individual as a whole being.
 Provide for professional performance at international standards
Step 9: Evaluations (5 minutes)
 What are the elements of nursing models and theories?

 What are the theories in nursing practice?

References
Alexander, M. F., Fawcett, J. N., & Runciman, P. J. (2002). Nursing practice (2nd ed.).
London: Churchill Livingstone.
Bewes, P. (2003). Surgery: A manual for rural health workers (2nd ed.). Nairobi: AMREF.
Black, J. M., & Hawks, J. H. (2009). Medical surgical nursing (8th ed.). Philadelphia: W. B.
Saunders.
Bloom, A., & Bloom, S. (1994). Toohey’s medicine: A textbook for students in the health
care professions (15th ed.). London: Churchill Livingstone.
Brigden, R. J. (1998). Operating theatres technique (5th ed.). London: Churchill Livingstone.
Brunner, L. S., & Suddath, S. D. (1999). Medical surgical nursing (9th ed.). Philadelphia:
Lippincott.
Colmer, M. R. (2005). Moroney’s surgery for nurses (16th ed.). London: Churchill
Livingstone.
Dixon, E. (1983). Theatre technique (5th ed.). London: Bailliere Tindall.
Ignatavius, D. D., & Workman, M. L. (1995). Medical surgical nursing. Philadelphia: W. B.
Saunder.
Hinchliff, S. (1996). Dictionary of nursing (17th ed.). London: Churchill Livingstone.
Lewis, S. M., & Collier, I. C. (1998). Medical surgical nursing assessment and management
of clinical problems. New York: Mosby.
Long, B. C., Phipps, W. J., & Cassmeyer, V. (1993). Medical surgical nursing: A nursing
process approach. London: Mosby.
MOHSW. (2005). National guidelines for the clinical management of HIV/AIDS. Tanzania:
MOHSW.
Monahan, F. D., & Sands, J. K., Neighbors, M., Marek, J. F., & Green, C. J. (2007). Medical
surgical nursing: Health and illness perspective (8th ed.). Canada: Mosby Elsevier.
Peattie, I. P., & Walker, S. (1995). Understanding nursing care (4th ed.). St. Louis: Churchill
Livingstone.
Watson, J. E. (1997). Medical surgical nursing and related physiology. London: Saunders.
Wilson, M. (1993). Surgical nursing (11th ed.). London: ELBS.

Session 5: Basic Nursing Procedures
Prerequisite
 Nursing Theories
 Tanzania Nursing Model
Leaning Tasks
 Mention basic nursing procedures
 Define common terms used in bed making
 Identify the purpose of bed making
 Outline principles of making hospital beds
 Identify the assessments and requirements for making various bed used in hospitals
Resources Needed
SESSION OVERVIEW

Presentation of Session Title and Students
learning tasks
2 10 minutes Presentation Introduction to Basic Nursing Procedures
Presentation/
3 10 minutes Common Terms Used in Bed Making
Discussion
Presentation/
4 15 minutes Purpose of Bed Making
Discussion
Presentation/
5 20 minutes Principles of Making Hospital Beds
Discussion
Assessments and Requirements for Making
Various Bed Used in Hospitals

SESSION CONTENTS
ASK students if they have any question before proceeding
Step 2: Introduction to Basic Nursing Procedures (10 minutes)
 Basic nursing procedures are the major skills required by nursing professional in
providing care to the patients
 Professional nurse should have knowledge and skills of basic nursing procedures for
provision of quality nursing care
 A nurse should have ability to assess patients’ needs and intervene accordingly
 The following are the Basic nursing procedures which is required in daily nursing
practice:
o Bed making
o Admission and discharge of patients
o Positions used in nursing
o Checking vital signs
o Moving, lifting and turning patients
o Head to toe assessment
o Administration of medicines
o Bathing patients
o Wound dressing
o Care of bedpans and urinals
o Collection, examination and disposal of specimen
o Physical assessment
o Care of dead body (Last office)
Step 3: Introduction to Bed Making (10 minutes)
 The qualified Nurse needs to clearly understand various terms used in nursing as well as
been able to perform those procedures in the health care setting.
 When the learner receives appropriate instruction and have an opportunity to perform
nursing procedures, it will help to gain skills and become a competent professional nurse.
 The bed is where the client will spend most of his time while in hospital.
 A properly made bed provides comfort to the person occupying it and contributes to
general ward tidiness.
 The nurse uses judgment to decide on the necessary bed modifications to suite the
condition of the particular client

Definition of Terms
 Bed: Is a couch or support for the body during sleep
 Bed making: Is a process of preparing patient’s bed in relation to his/her condition
 Bed Accessory: These are additional requirement used during bed making to promote
comfort of the patient e.g. sand bags, back rest, bed cradle bed blocks.
 Unoccupied bed: Is an empty bed
 Occupied bed: Is the bed having a patient
 Post operative bed: Is the bed made for receiving a patient from the operating theatre
after undergoing a surgical procedure
 Cardiac bed: Is the bed used for nursing patient with certain cardiac disease and some
respiratory infections
 Amputation / Divided bed: is the bed made for patients with amputation of the lower
limb
Step 4: Purposes for Making Beds (20 minutes)
ASK students to brainstorm on the purposes for bed making in hospitals for 2 minutes
 To promote safety and comfort of the patient

 To facilitate specialized care
 To facilitate easy breathing of clients e.g. beds for cardiac or asthmatic patients
 To provide a hygienic and comfortable sleeping area for clients
 To prevent odour from sweat and soiled linen
 To provide neatness of the ward
 To provide easy visualization of the operated part
 To provide proper alignment of bones e.g. fracture bed
 To prevent bed sores by ensuring there are no wrinkles to cause pressure points
Step 5: Guiding Principles for Making Hospital Beds (15 minutes)
 Prepare yourself for the procedure by making a systematic plan for time and effort.
 Collect all requirements before starting the procedure by arranging them in order for use.
 Inform the patient about the procedure and assess his condition as whether he can get out
of the bed or not.
 Two nurses are advisable in bed making so as to make the procedure easier and
successful provides safety for the patient.
 Remove all soiled linen from top of bed to bottom and avoid linen touching the floor,
your face and uniform. Don’t shake or fan linen to prevent spread of micro-organisms and
dust.

 Maintain privacy for the patient, avoid exposing him unnecessarily, and use screens
where necessary.
 Communicate with the patient while making his bed, encourage him to express his
feelings, needs and problems.
 Utilize principles of body mechanics and use each movement during bed making. Have
your centre of gravity close to your base of support, avoid twisting your body, stand
facing the direction which your work.
 Adhere to Infection, Prevention and control measures
Step 6: Assessments and Requirements for Making Various Beds Used in

Hospitals (20 minutes)
Assessments
 Determine patient’s condition and needs
 Obtain information on the type of bed needed
 Determine the materials needed including the bed accessories
 Check for special precautions or considerations to be taken while changing the client’s
bed.
 Determine how much can the client assist in the procedure
Equipment
 Two or more bed sheets (depending on the type of bed)
 One draw mackintosh
 One draw sheet
 One or more pillows and pillow cases
 one or two blankets (depends on client’s condition and weather)
 One counterpane
 One laundry bag
 One chair
 Bed accessories as required e.g. backrest, bed cradle, sand bags, fracture boards bed
elevators pulleys
 Gloves (depending on the condition of the bed/patient)
 Trolley
 Nursing: is a profession within the health care sector focused on the care of individuals,
families, and communities so they may attain, maintain, or recover optimal health and
quality of life
 The practice encompasses with caring, autonomous, sharing and collaboration with other
health care team.
 Learning the basic nursing care and its procedure is fundamentals of all nursing practice
for quality care.

 What nursing and ethics?

 What are the basic nursing procedures?
 Outline principles of making a bed in hospitals
References
Wilkins.
Profession.
Wilkins.

Session 6: Making Occupied and Unoccupied Beds
Prerequisites
 None
Students learning Tasks

 Identify types of beds made in hospital
 Indication for making an occupied bed and un occupied bed
 Describe the procedures in making un occupied and occupied beds in hospitals
 Demonstrate steps for making beds in hospitals
Resources Needed
 Overhead project
SESSION OVERVIEW

Lecture Presentation of Session Title and
1 5 minutes
Learning Tasks
2 25 minutes Buzz/Lecture/ Discussion Types of Beds Made in Hospital
Lecture/Demonstration/ Perform Bed Making for Unoccupied

3 80 minutes
Discussion Bed and Occupied Bed
SESSION CONTENT
READ or ASK students to read the related asks and clarify


NTA Level 4, Semester 1 48 Session 6: Making Occupied and Unoccupied
Beds
Step 2: Various Beds Made in Hospitals (25 minutes)
Activity: Buzzing (10minutes)
TELL the students to pair up and mention various beds made in the hospitals for 5 minutes
ALLOW few students to respond and let other pairs to provide unmentioned responses
CLARIFY and summarize by using the information below
Beds made in hospitals

 Unoccupied Bed
 Occupied Bed
 Post-Operative Bed
 Cardiac Bed
 Amputation Bed
Step 3: Procedures in making beds in hospital (80 minutes)
ASK the students to brainstorm on how to make an occupied and occupied bed
ALLOW few students to respond and let others to provide unmentioned responses
WRITE their responses on the flip/board
CLARIFY, demonstrate and summarize by using the information below
Making Unoccupied Bed

Steps:
 Wash hands and dry to prevent spread of infection
 Assemble all required supplies and place them on the trolley to facilitates easy
performance
 Take trolley to the bed side
 Place bottom sheet in the middle of the bed, rough side edge facing down towards the
mattress
 Tuck the sheet well under the top of the mattress using ‘envelop corners’. Then tuck the
bottom side, pulling tight to prevent wrinkles.
 Place the draw mackintosh and draw sheet on the bed so that it will be under the patient’s
buttocks
 Place the top sheet on the bed so as the top edge become even with the top edge of the
mattress, the rough edge side facing up
 Place the blanket and counterpane over the top sheet (right side up).
o Bring them even with the top of the mattress.
o Tuck the bottom end under the mattress, leave the sides hanging
 Fold the top linen back at the top so that bottom sheet is revealed
 Make a pleat of top linen at the bottom to prevent pressure on the feet of the client
Beds
 Put pillow cases and place at the end of the bed.
Figure 1: Unoccupied bed
Source: Retrieved from https://www.google.co.tz/search?hl=en&biw
Making an Occupied Bed

Indication: Bedridden patients (i.e. unconscious, helpless, and patient with fractures)
Method: Side to side
Steps
 Inform the client about the procedure to foster cooperation
 Meet the patient’s needs before starting the procedure e.g. urination, defecation
 Two nurses should work together if convenient
 Screen the bed to provide privacy
 Place the chair at the foot of the bed
 Place the trolley with clean linen and laundry bag within easy reach
 Wash hands and put on gloves if necessary
 Loosen top linen, remove counterpane starting from top to bottom, fold it into three and
place it on the back of the chair
 Repeat with the blanket(s), but leave the top sheet on the patient to avoid exposure
 Remove pillows but leave one under the patient’s head to ensure comfort
 Ask the patient to move or roll to the far end of the bed and assist him as necessary,
facing away from you
 Loosen bottom sheet, mackintosh, and draw sheet
 Roll sheets separately towards the patient, tuck each roll as close to the patient as
possible
 Place the clean sheet on the bed, tuck near edge under the mattress.
o Roll far end and tuck under the patient
 Unroll the mackintosh, stretch it over the bottom sheet and tuck edge under the mattress
 Place the clean draw sheet on the bed, tuck near edge under the mattress.
o Roll far end and tuck under the patient
 Place clean sheet on the patient. Remove the soiled top sheet by sliding it from
underneath the clean one to avoid exposure of the patient
 Ask patient to move or roll over the ridge of tucked linen to the clean side of the bed.
Assist as necessary.
 Loosen soiled bottom linen, remove from bed and discard into the laundry bag.
 Pull bottom sheet to proper position, tuck under the mattress
 Straighten the sheet, tuck the bottom side under the mattress
Beds
 Place the blanket and counterpane over the top sheet; tuck the bottom end under the
mattress.
 Fold the top sheet back over the blanket and counterpane.
 Tuck the sides under the mattress
 Put pillows in clean pillow cases and place under the patient’s head
 Make sure the patient is comfortable in bed
Changing Bottom Sheet

Method: top to bottom
 Take a clean sheet; roll it from one end leaving 30 cm unrolled. Put it on trolley
 Roll the draw mackintosh and draw sheet in the same manner, put them on trolley
 Inform the client about the procedure
 Lower or remove the backrest if any
 Wash hands and dry, put on gloves
 Ask patient (while in sitting position) to move far down the end of bed as convenient,
assisting him in doing so. If he is unable to move, two nurses will support and lift him
down the bed
 Remove the pillows, draw sheet and draw mackintosh
 Roll the bottom sheet down to the patient’s buttocks
 Spread the clean bottom sheet, with the rolled side against the roll of the soiled linen.
Tuck it at the top under the mattress
 Replace the draw mackintosh and draw sheet in position
 Replace backrest and pillows
 Assist the patient to move over the rolled up sheet to the top side of the bed with his back
resting on the pillows
 Remove the soiled bottom sheet, discard to the laundry bag
 Unroll the clean bottom sheet, tuck at the bottom as for unoccupied bed
 Change the top sheet and complete making the bed as for the occupied bed
 Ensure comfort of the patient

Beds
Figure 2: Occupied bed
Source: Mosby nursing assistance skills

 Types of bed made in the hospital include unoccupied bed, occupied bed, post operative
bed, cardiac bed and amputation/divided bed
 Steps for making occupied and un occupied bed
 Occupied bed is made for bedridden patients.
 Consider the patient’s condition when changing the bottom sheet while making occupied
bed.

 What are the types of bed made in the hospitals?
 Identify the indication for making occupied bed
 Outline extra requirements for making occupied bed
ASK students if they have any comments or need clarification on any poin
References
Wilkins.
Profession.
Wilkins.
Beds
Session 7: Making Post-Operative Bed
Prerequisites
 Making unoccupied bed
Students Learning Tasks

 State indication for post-operative bed
 Describe the procedure for making post-operative bed
 Demonstrate steps for making post-operative bed
Resources needed
SESSION OVERVIEW

Presentation of Session Title and
Learning Tasks
2 5 minutes Presentation/Brainstorm Indication of Post-Operative Bed
3 40minutes Discussion/Demonstration Making a Post-Operative Bed
SESSION CONTENT
READ or ASK students to read the Learning Tasks and clarify

ASK students if they have any question before you proceeding

Step 2: Indication of Post-Operative Bed (5 minutes)
ACTIVITY: Brainstorming (5 minutes)
ASK the students to brainstorm on indication of post-operative bed
CLARIFY, demonstrate and summarize by using the information below Post operative
patient
Step 3: Making Post-Operative Bed (40 minutes)

Equipment
 As for unoccupied bed
Additional requirement:
 Resuscitation tray (at bedside)
 Drip stand
 Bed blocks
 Post operative tray
 Hot water bottle
 Small mackintosh and towel to protect beddings, put under patient’s head
 Vomiting bowl
Steps:
Make the bed as for an unoccupied bed with the following differences
 Leave the top bed clothes loose
 Fold back the top end of the bed clothes about 50 cm and do the same for the bottom end
 Fold each side of bed clothes to meet at the centre
 Fold one side on top of the other
 Fold in half from top to bottom to make a small park (square)
 Place the pillows on a chair
 If hot water bottle is used to warm the bed, make sure it is removed before the patient is
put in bed
 After the patient is put in the bed, bring the pack of clothes place it over the patient and
loosen them
 Cover the patient and tuck the ends as for an occupied bed
 Post operative bed is made for the post operative patient

 Hot water bottle are put in the bed to warm the beddings
 Resuscitation tray should be put at the bed side of the patient

 What are the reasons for making post-operative bed?

 What are the steps to be followed in making post-operative bed?
References
Wilkins.
Profession.
Wilkins.

Session 8: Making Cardiac and Divided Beds
Prerequisite
 Making unoccupied bed
Students learning tasks

 State purposes for making cardiac and divided bed
 Describe the procedure for making cardiac bed and divided bed
 Demonstrate steps for making cardiac and divided bed
Resources needed
SESSION OVERVIEW
Presentation Presentation of Session Title and
1 5 minutes
Learning Tasks
Purpose for Cardiac Bed and
2 20 minutes Buzz/Presentation
Amputation Bed
Presentation/ Prepare a Cardiac Bed and
3 85 minutes
Demonstration Amputation Bed
SESSION CONTENT

ASK students if they have any question before you proceeding

Step 2: Purpose for Cardiac Bed and Amputation Bed (20 minutes)
ASK the students to brainstorm on purposes for making cardiac bed and divided bed
Purpose for cardiac bed

 This procedure is used for patients who have to be nursed in upright
Position e.g. Patients with asthmatic and cardiac conditions
Purpose for amputation bed

 To avoid weight of bed clothes on the stump for clients who had amputation of the lower
limbs
 For easy viewing of the amputated limb such as observation of any discharge or bleeding
Step 3: Making a Cardiac Bed and Divided Bed (85 minutes)
Cardiac bed
Requirement: As for an unoccupied bed
Additional requirement:
 Extra pillows
 Backrest
 Cardiac table (if available)
 Air rings when necessary
Steps:
 Prepare unoccupied bed
 Place the backrest at the head of the bed
 Put extra pillows so that the patient is comfortable in sitting up position
 Position the heart table across the bed with required pillows on it so that the patient may
lean forward to rest his head and arms as need arises
 Make sure bedclothes are enough to provide comfort
 Place an air ring under the patient’s buttocks if necessary
Divided (amputation) bed

Assessment:
 Is there any bleeding from the stump?
 Does the patient’s condition allow for bed making?
 Is there enough linen?

Equipment: As for unoccupied bed
Additional equipment:
 A pair of large sheets
 A pair blankets
 Bed cradle
 Bed cover
 Soft pillow
 Sand bags
Steps for the procedure:

 Prepare the unoccupied bed as far as the draw sheet
 Position the bed cradle
 Make top half of the bed, fold the bed clothes to reach the middle of the bed
 Make the bottom half in the usual way, and let it overlap the top half
 Tuck in the bottom and the sides
 The sand bags are to be placed on either side of the amputated stump
 Cardiac bed is made for patients who have to be nursed in upright position
o e.g. Patients with asthmatic and cardiac conditions
 Observe the client for any abnormalities as you make the bed
 Never expose the client at any time of the procedure
 Keep on communicating with the client as you proceed with the procedure
 Make sure the sand bags are correctly secured
 State the purposes of making cardiac bed

 Outline the steps to be followed in making cardiac bed
 Outline the importance of keeping the affected area to be viewed easily
 State the purpose of divided bed

References
Wilkins.
Profession.
Wilkins.

Session 9: Admission and Discharge of a Patient
Prerequisite
 Communication skills
Learning Tasks
 Define common terms used in admission and discharging of a patient in the hospital
 Mention types of admission of patients in the hospital
 Identify reasons for admitting and discharging patients in the hospital
 Demonstrate the procedure of admitting patient in the hospital
 Demonstrate the procedure for discharging patient from the hospital
Resources needed
SESSION OVERVIEW
Step Time Teaching activities Content
1 5 minutes Presentation Overview of Students Learning Tasks

Common Terms Used in Admission and
Discharging of Patients
Presentation/ Types of Admission of Patients In The
3 10 minutes
Buzz Hospital
Presentation/ Reasons for Admitting and Discharging
4 15 minutes
Discussion Patients in the Hospital
Presentation/
Procedure of Admitting Patient in the
5 30 minutes Group Discussion and
Hospital
Demonstration
Presentation Procedure for Discharging Patient from
6 30 minutes
Demonstration the Hospital

NTA Level 4, Semester 1 60 Session 9: Admission and Discharge of a
Patient
SESSION CONTENT

READ or ASK students to read the students learning tasks and clarify
ASK students if they have any questions before proceeding
Step 2: Common Terms Used in Admission of Patients (10 minutes)

Introduction
 The admission procedure can be positive or negative experience for a patient. The
impression that is formed by the patient during the admission process has a strong effect
on his attitude towards the total care regimen.
 Nurses should consider this process as a key step in patient’s adaptation to environment
and care
 Discharge from hospital can be a welcome relief for the patient, but it can also be an
anxiety and fear. Adequate preparation must be made to help transfer from a dependent
role to a more independent role. During this transition, nurse can facilitate the process by
being aware of the individual patient’s needs including physical, emotional and
psychological needs of both patient and family.
Common Terms
 Admission: Is a process of receiving patents with serious health problems to a health
facility for diagnosis/investigations, care and treatment
 Assessment: Is the collection, organizing, validating and recording data about a client’s
health status.
 Discharge: Is an official permission granted to a patient to leave the health facility
 Convalescence: Is the period of recovering after the termination of a disease or operation
Step 3: Types of Admission (10 minutes)

ASK students list the types of admission
ALLOW few students to respond and let others provide unmentioned responses
CLARIFY and summarize using the information below
 Planned admission: The patient is admitted from a waiting list or as a booked case
 Emergency admission: The patient is admitted following an accident or acute illness

Patient
Step 4: Reasons for Admitting and discharging a Patient in the Hospital (15
minutes)
ASK the students to brainstorm on reasons for admitting and discharging patients from the
hospital for 5 minutes
WRITE their response on the flip chart/board
Reasons for admitting

 To provide treatment and care for the patient
 To obtain baseline data on the patient’s condition which involves Observation ,
Investigation and Diagnosis procedures
Reasons for discharging

 Assist a patient to transfer positively from a dependent to a more independent role
 To help relatives to provide an environment that best meet the needs of the patient
 Obtain relative and community support of the client during convalescence at home
Step 5: Procedure of Admitting a Patient in the Hospital (30 minutes)

Assessment:
 Patient’s physical, emotional and intellectual status
 Patient’s ability to adopt to the environment
 How much the patient understands about his illness and the imposed effects
 If patient is allergic to any drug
 Whether the patient is taking any medication
 The patient’s ability to perform self-care
Preparation of the environment

 Identify suitable place for the patient
 Ensure safe and conducive room
Preparation of the patient

 Discuss information regarding admission to the patient and relatives
Preparation of the nurse

 Revisit the policy guideline for admission as per institution
 Check own competency on the procedure
 Review literature on admission procedure, review the policy

Patient
Preparation of the necessary requirement:
 Admission book and observation chart
 Inpatient continuation sheets and drug sheets
 Observation tray containing thermometer, cotton wool swabs, container for used swabs,
antiseptic, sphygmomanometer and stethoscope
 Equipment for taking blood, urine and stool specimen
 Laboratory forms
Steps for Admission of a patient in a hospital

 Welcome and greet the patient and relatives
 Introduce yourself and your position to allay anxiety
 Offer a chair for patient and relatives to sit
 Introduce the patient to other members of the staff present
 Obtain report from the escorting nurse or relative
 Assess the patient for self-care
 Explain hospital routines
 Orient patient to the ward environment and its facilities
 Complete physical assessment and history of patient to make nursing diagnosis
 Observe verbal and non verbal expressions indicating pain, fear and anxiety
 Obtain patient’s body weight
 Obtain specimen as per hospital routine
 Re assess patient’s level of comfort
 Begin patient’s nursing care plan
 Notify admitting doctor and obtain orders
 Record nurse’s observations on the patient’s chart
 Receive and record patient’s valuable as per hospital routine
 Assist patient to his bed and introduce him to other patients in the room
Step 6: Procedure for Discharging a Patient from the Hospital

(30 minutes)
Assessment:
 What is the needed information about the physical, emotional and psychological needs of
a client
 What disabilities and limitations that will extend after discharge
 Are home plans well understood
 What areas must be involved in teaching the client
 How much is the family involved in continuing to support the patient at home
Preparation of the patient:

Equipment:
 Patient’s chart and discharge summary note
 Admission and discharge register
 Daily returns form (census sheet)
 Medication for home use
 Educational pamphlets as required
 Specific equipment needed upon discharge e.g. insulin syringe

Patient
Steps for discharging a patient from the hospital
 Start planning for discharge early while the patient is still in hospital
 Verify discharge orders from patient’s doctor
 Collaborate with appropriate heath team members
 Order any equipment or supplies patient will need to take home
 Coordinate with patient and family regarding time and day of discharge and mode of
transportation
 Talk with patient about his future expectation regarding his health
 Encourage patient to verbalize his concern and be alert or nonverbal clues
 Discuss with family or significant others on how they can help the patient to maximize
potential
 Teach on self-care at home where possible and supply written instructions
 Evaluate patient’s understanding of teaching
 Assist patient to put together all his belongs and assist him in packing
 Collect required medication for home use from pharmacy. Repeat instructions for use to
patient and relatives
 Give the discharge form to patient and make sure the instructions regarding medication,
diet, exercise and date for follow up appointment are clear
 Collect patient’s valuables and countercheck with him to make sure that everything is in
order
 Assist client to dress his home clothes
 Instruct patient or relatives to settle the hospital bills
 Escort client to his transport and say ‘bye’
 Strip the bed and put linen into the laundry bag
 Clean the bed thoroughly using disinfectant and re make it
 Empty the locker or bed side table and clean for the next client
 The impression which is formed by the client during the first contact will always last and
may affect his attitude towards care received
 Observe verbal and non verbal expressions indicating pain, fear and anxiety
 Accurate and appropriate documentation is necessary during the process of admission
 Involve the patient or relatives as much as possible in the plan of patient’s care
 Plans for client’s discharge should start early, and be incorporated in client’s total care. It
should not be left until the day of going home
 Collect patient’s valuables and countercheck with him to make sure that everything is in
order
 Assist to transfer the client on a wheel chair or stretcher to the car in situations where the
client is unable to walk
 Encourage patient to verbalize his concern and be alert or nonverbal clues
 Teach on self-care at home where possible and supply written instructions and evaluate
patient’s understanding of teaching

Patient
 What are the importance of encouraging the patient participate in his plan of care?
 How should you do to make the patient express his feelings and concerns clearly and
freely?
 Explain briefly the importance for the patient to verbalize his feelings and concerns
during discharge.
 How will you instruct patient and relative on discharge?
 What is the procedure of discharging or transferring a patient from one unit to another
unit?
References
Wilkins.
Profession.
Wilkins.

Patient
Session 10: Checking a Patient’s Vital Signs
Prerequisite
 Anatomy and physiology
Students learning Tasks

By the end of this session, students expected to be able to:
 Define common terms used in checking patients vital signs
 Identify reasons for checking patients vital signs
 Demonstrate the procedure of checking patients vital signs
Resources Needed
Session Overview
Step Time Teaching activities Content
Presentation Presentation of Session Title and Learning
1 5 minutes
Tasks
Common Terms Used Checking a Patient’s
Vital Signs
3 10 minutes Buzzing/Presentation Reasons for Checking a Patient’s Vital Signs
Presentation/
Procedure of Checking a Patient’s Vital
4 80 minutes Demonstration
Signs
SESSION CONTENT
ASK students if they have any questions before proceeding

Step 2: Common Terms Used in Checking Vital Signs (15 minutes)
Temperature
 Temperature: Is the state of hotness or coldness of a substance as measured by a
thermometer
 Body temperature: Is the measure of warmth or coldness of the body resulting from
body metabolism. It is the balance between heat production and heat lost. Normal body
temperature range from 36.5oC- 37.5oCdepend on the site taken
 Thermometer: Is an instrument used to measure the degree of heat or cold
 Clinical Thermometer: Is a thermometer for measure body temperature (Example of
thermometers used in clinical settings are mercury and electronic)
 Fever: Is abnormal elevation of body temperature.
 Pyrexia: Is elevated body temperature. Ranging from 38o C – 41oC
 Hyperpyrexia: Is an extremely elevated body temperature ranging from 41o C and above
 Hypothermia: Is abnormal body temperature below 36o C
 Constant Fever: The patient’s body temperature is constantly high throughout a period
of some days. The fluctuation between morning and evening temperature doesn’t exceed
1oC.
 Intermittent Fever: The patient’s body temperature swings from normal or subnormal to
high fever regularly.
 Remittent Fever: The patient’s body temperature may fall by more than 10C in the
morning and rise again later in the day. The characteristics fact is that the temperature
does not reach the normal within twenty four hours.
 Inverse Fever: The patient’s body temperature is high in the morning and low in the
evening.
 Irregular Fever: The patient’s body temperature rises and falls without definite pattern.
 Relapsing Fever: The patient’s high body temperature falls to normal and remains
normal for a day or two and then it rises again
Pulse
 Pulse: Pulse is a wave of contraction felt in the arterial walls when the left ventricle
contract or is the vibration produced by heart beat waves of blood through the arteries
 Pulse Rate: (heart rate) Tells how often a person’s heart beats or Is the frequency of
heart beats per minute, normal adult pulse rate ranges from 60-80 beats/minute (average
beats per minute is 72), Newborn 120 beats/minutes, 4-8 years child ranges from 90-
100beats/minutes
 Bradycardia: Is the term describing adult pulse rate below 60 beats/minutes
 Tachycardia: Is the term describing adult pulse rate above 100 beats/minutes
 The Rate: This is the speed at which the heart is beating.
 The Rhythm: Is the regularity of the heart; a normal pulse has beats of uniform force and
separated by equal intervals.
 The Volume: Is the strength of the beats, it indicates the power of the heart and the
amount of the blood in circulation.
 Common anatomical sites for taking pulse rate are:
o Radial pulse: Is palpated on the radial artery with the patient’s arm positioned
alongside the body, palm downward
o Temporal pulse: Is palpated on the superficial temporal artery, which passes
upward just in front of the ear.
o Carotid pulse: Is palpated on carotid artery which is located alongside of the neck.
o Femoral pulse: Is palpated on the femoral artery located half way between the
anterior superior iliac spine and symphisis pubis, below the inguinal ligament.
o Brachial pulse: Is palpated on the bronchial artery which is located near the center of
the antecubital space, towards the little finger.
o Popliteal pulse: Is palpated on the popliteal artery behind the knee in the popliteal
fossa when the patient’s leg is flexed.
o Pedal pulses.
o Dorsalis pedis pulse: Is palpated on the dorsalis pedis artery which lies on the
dorsum (top) of the foot with plantar flexed, if possible.
o Posterior tibia pulse: Is palpated behind and below the medial malleous of the ankle
o Apical pulse: Is measured by listening over the apex of the heart on the left side of
the chest using a stethoscope.
o Apical- radial pulse: Is sometime required when a patient has a cardial vascular
disorder.( two person are needed to take this pulse whereby one measure apical pulse
by using stethoscope while other palpating pulse on the radial artery at the same
time). Should be counted for fully minutes using a single watch that is placed in a
convenient location where both people can see easily
o Pulse deficit: Is the difference between the apical pulse and radial pulse beats
Respiration
 Respiration: Is the process of breathing in oxygen and exhaling out carbon dioxide
o External respiration Is the exchange of gases between lungs and atmosphere
o Internal respiration Is the exchange of gases between blood and cells
 Dyspnea: Is a condition where the person experience difficult in breathing
 Wheezing: Is production of whistling sound during difficult breathing as occurs in
asthmatic patients
 Apnoea: Is term describing a temporary cessation in breathing
 Orthopnoea: This is inability to breath easily and freely unless patient is in a sitting – up
position
 Croup: Is noisy or harsh- sounding sort of breathing due to laryngeal obstruction
(common causes of the obstruction are oedema or spasm or could both)
Blood pressure
 Blood pressure: Is the force exerted by the blood against the arterial walls. Normally is
recorded as systolic/diastolic in millimeters of mercury (mmHg)
 Systolic pressure: Is force exerted when the left ventricle contracts and pushes blood out
of the heart through the Aorta. It ranges from 110-140mmHg for adult.
 Diastolic pressure: Is the force of the blood against the arterial walls when the heart is at
rest between beats. It ranges from 60-90mmHg for adult
 Pulse pressure: Is the difference between systolic pressure and diastolic pressure
 Hypertension: Is when the systolic blood pressure is over 160mmHg or/and diastolic
pressure is over 100mmHg
 Hypotension: Is when the systolic blood pressure is bellow 100mmHg or/and diastolic
blood pressure is bellow 60mmHg.

Step 3: Reason for checking a patient’s vital signs (10 minutes)
TELL students to pair up and buzz for 2 minutes.
 To identify any abnormalities /changes in body functions

 To evaluate patient condition during admission, before discharging, before and after any
invasive medical /surgical procedure or treatment
 To assist physician to make a change in medications
Step 4: Procedure of checking vital signs (80 minutes)

Procedure taking body temperature by Axilla or Groin
Assessment:
 Make sure the patient has not taken bath recently
 Assess if the patient is very thin or having discharging lesions in the groin or axilla
Equipment:
A clean tray containing:
 A rack with thermometers
 Galipot with cotton wool swabs
 Kidney dish for used swabs
 A small bottle with spirit
 Temperature charts
 Watch with second hand or pulsometer
 Pen for recording the findings
Steps for taking temperature in axilla or groin

 Inform patient or relative about the procedure, perform quick assessment to make sure the
patient is ready for the procedure
 Wash hands and prepare the equipment
 Ensure that the skin surface of the axilla (arm pit) or groin is dry
 Wipe the thermometer with cotton wool from the bulb to the stem
 Take and read the thermometer to make sure that mercury level is below 35°C
 Place the thermometer in the axilla or groin with the bulb totally surrounded by the skin
 Ask or assist the patient to place his arm across the chest with fingers on the opposite
shoulder
 Leave the thermometer in place for 5 to 10 minutes, making sure the clothes do not
interfere with the thermometer
 If the temperature is taken from the groin, ask or assist the patient to cross one thigh over
the other and leave it in place for 5 to 10minutes
 Take the thermometer out of axilla or groin; wipe it with cotton wool swab starting from
the stem to the bulb. Avoid contaminating your fingers

 Discard the used swab into the kidney dish
 Hold the thermometer at eye-level and rotate slowly until the column of mercury is seen
clearly
 Read mercury level accurately
 Place the thermometer in the container for used thermometers
 Record the temperature accurately on the patient’s chart
 Thank the patient and leave him comfortable
 Clear up equipments and wash hands
 Report or take immediate action on the abnormalities noted
Procedure on Taking Pulse Rate

Assessment:
 The patient’s level of activity prior to performing the procedure
 The patient’s temperature
Equipment:
 Observation chart
Steps:
 Explain to the patient about the procedure
 Perform hand washing
 Assist the patient to the comfortable position – lying or sitting
 Place two or three finger tips on the radial artery at the inside of the patient’s wrist
 Look at your watch and count the pulse beats for the whole minutes. If pulse is normal
count for 30 seconds and then multiply by 2 to get the beats per minute)
 Continue placing the finger tips on the artery and evaluate the strength and regularity of
the beats
 Record the findings on the patient’s chart and communicate to the ward in charge. This
will include –beats per minute, strength ( strong, weak, or thread) and rhythm whether
regular or irregular
 Thank the patient and perform hand washing
Taking Respiration Rate

Assessment:
Is the patient experiencing respiratory distress after exercise period?
Equipment:
 Patient’s chart
Steps
 With your fingers still resting on the patient’s wrist after checking pulse, observe the
patient’s chest for inspiration and expiration movements
 Count the respirations for full minute or you may count for 30 seconds and then multiply
by two to get the rate per minute
 Assess the respiratory qualities such as wheezing, stridor, deep or shallow breathing.
 Remove the fingers and record the findings on patient’s chart

Procedure of checking blood pressure
Factors Responsible for Maintenance of blood pressure
 The Cardiac output
o When the force of the ventricular contractions is enough blood is pumped into the
arteries resulting in increased blood pressure.
o When the pumping action of the heart is weak, the blood pressure decreases.
 The Amount of Blood in Circulation
o When the blood volume is increased as when the patient gets blood transfusion or
intravenous fluids the blood pressure increases.
o When the blood volume is low as in haemorrhage the blood pressure decreases.
 The Viscosity of the Blood
o Is the thickness of the blood which is dependent upon cellular components.
o The more viscous the blood is, the more force is needed to pump it into the arteries
thus causing the rise in blood pressure.
 Peripheral Resistance
o Decreased sizes of blood vessels (small lumen) due to constriction necessitate a
greater force to pump blood through the vessels thus increasing the blood pressure.
o Increases in size of blood vessels, (wider lumen), due to vasodilatation results in
lower blood pressure.
 Elasticity of the Blood Vessel Walls
o Normally walls of blood vessels have elastic tissue which allows them to stretch and
shrink according to the heart beats.
o In diseases such as arteriosclerosis or in old age the elasticity of the walls of blood
vessels decreases considerably causing a rise in blood pressure.
Assessment:
 History of elevated blood pressure
 If the client is on antihypertensive therapy
 If he has been exposed to physical exercises within the last 10 minutes
Equipment:
 Sphygmomanometer (Aneroid, Mercury and electronic manometers)
 Stethoscope
 Patient’s chart
Steps for Checking Blood pressure

 Explain the procedure to the patient
 Wash hands and dry
 Prepare the equipment, check if they are in good working condition.
 Position the client in sitting or lying
 Expose the left arm as necessary
 Apply the calf on the client’s bare arm, above the antecubital space
 Palpate the brachial artery and place the stethoscope over the pulse point
 Position the sphygmomanometer so that the gauge is visible for reading
 Put the stethoscope in your ears, close the valve on the bulb of sphygmomanometer,
pump the mercury until it rises to 40 mmHg above the anticipated systolic pressure
 Release the valve slowly while listening the pulse beats. Note the number on the gauge at
which you hear the first beat is the systolic pressure

 Continue deflating the cuff slowly and listening the muffling sound and note both the
points of muffling and the number at which the beats disappears, this is a diastolic
pressure
 Remove cuff from the client’s arm, and position him comfortably
 Record findings on client’s chart
 A nurse should be able to identify reason of checking vital signs

 Should be knowledgeable on checking vital signs and results interpretation
 What are the vital signs?

 What is importance of checking vital signs?
References
Wilkins.
Profession.
Wilkins.

Session 11: Administration of Oral Medicines
Total Session Time: 120
Prerequisite
 None
Learning Tasks
 Define common terms used in drug administration
 Identify reasons for drug administration
 Demonstrate the procedure of drug administration
Resources Needed
SESSION OVERVIEW

Presentation of Title and Students Learning
Tasks
Common Terms Used in Oral Drugs
2 5minutes Presentation
Administration
3 15 minutes Buzzing/Discussion Reasons for Oral Drugs Administration
Presentation/
4 85 minutes Procedure for Oral Medication
Demonstration
6 5minutes Presentation Evaluation
SESSION CONTENT
Step 1: Presentation of Session Title and Students Learning Tasks

(5 minutes)

Step 2: Common Terms Used in Oral Drug Administration (5 minutes)
Introduction:
 Medicines for hospitalized clients are written by the doctors on the client’s drug sheet and
in the file.
 It is important for the nurse giving the medication to check a medicine against the original
order to make sure the order is correct.
 Every time nurse gives medication should adhere to the basic principles of safe
medication – the five “rights” which are: - right drug, right dosage, right route of
administration, right time and right client.
 She should also to appreciate that a client has two other “rights”, right to know the reason
for taking the drug and right to refuse the drug.
 In these circumstances, errors occurring in medication should be minimal
Common terms used in oral medication

 Medicine: Is a drug or remedy or Treatment of disease by medical, as distinguished from
surgical treatment
 Medication: Is the medicinal substance used to treat disease, a drug or Treatment with
remedies
 Dose: Is the amount of medicine or radiation to be administered at one time
 Route: is the path by which a drug, fluid, poison, or other substance is taken into the
body
Step 3: Reasons for Oral Drug Medication (15 minutes)
TELL students to pair up and buzz for 2 minutes
 To administer medication in a safe, cheaper and most convenient way

 To achieve a therapeutic blood level of drug
 To promote client’s well-being – emotionally, physically and physiologically.
Step 4: Procedure for Oral Drug Administration (85 minutes)

Assessment:
 Is the drug to be administered valid?
 What is the current condition of the client?
 Is it the appropriate time for the procedure?
 Is the client currently taking any medication?
 Is the client able to swallow the tablet/capsule?
 Is the client allergic to any drug?

Equipment for Oral Drug administration:
Top Shelf:
 Drug sheets
 Medicine arranged in the order in which they can easily be read
 Bottle or jug of clean water
 Medicine measures and spoons
 Medicine dropper
 Small tray or plate
 Straws if needed
 Medicine towel and hand towel
 Pen and paper for recording
 Medicine grinder
Bottom Shelf:
 Bowl of warm soapy water
 Bowl of cold clean water for rising
 Bowl for used spoons and medicine measures
For Administration of Tablets and Capsules Medicines

 Ensure all clients are in their beds before starting medicine round
 Wash your hands and dry
 Take client’s drug sheets and call them by their names
 Select drug bottle(s)
 Remove bottle lid and pour the required tables or capsules into the bottle lid rather than
medication cup or spoon to avoid contamination as too many tablets come out
 Put all tables and /or capsule which are to be taken at the same time in one medicine cup
 Give tablets to the client with a cup of water for swallowing. Advise him to swallow one
at a time. Make sure he swallows all before you leave his bed side. Advise client to
swallow tablets/ capsules in a sitting up position to avoid aspiration if lying down
 Record the drugs in the client’s drug sheet and put your initials as required.
For Administration of Oral Liquid Medicines:-

 Identify the bottle and read label
 Hold the bottle in your right hand with label uppermost to prevent medicine from running
down the label while pouring and obscure it.
 Shake the bottle by inverting, Remove lid, Place it on the trolley so that the inside faces
up to keep it clean
 Pour the prescribed amount of the drug into the measuring cup holding the cup at eye
level and placing the nail of the left thumb as the mark to which the medicine should
reach
 Replace the lid
 Take the medicine to the client, assist him as necessary and ensure he has swallowed it all
 Put the cup in the bowl at the bottom shelf of the trolley
For administering Liquid iron:

 Measure the required amount
 Offer client a straw to drink with in order to avoid teeth discoloration
 Give client a glass of cold water to rinse the mouth immediately
 Alert client on possible abdominal discomfort and black stools
 Return drugs to the medicine cupboard and clear equipment
 Refuse to administer any medication which in your opinion will cause harm to
Patients
 Chart all the medicines as soon as client as taken them to avoid forgetting and prevent
accidental repetition of a dose by someone else
 Drugs requiring specific assessment of the client should be put in a different cup to avoid
the possibility of forgetting to check e.g. pulse rate for digoxin and respiration for
morphine
 Keep the medicine trolley in sight throughout the procedure
Step 7: Evaluation (5minutes)
 How to ensure that drugs have been administered safely and effectively?
 What is the importance for the nurse to check patient’s pulse and/or respiration before
giving digoxin or morphine?
 What are the client’s rights to be considered during medication
 What are the principles of medication
References
Wilkins.
Profession.
Wilkins.

Session 12: Administration of Medicine by Injection
Prerequisites
Learning tasks
 Define common terms used in drug administration
 Identify reasons for drug administration
 Demonstrate the procedure of drug administration
Resources Needed
SESSION OVERVIEW

Presentation/ Definition of Common Terms Used
2 10 minutes
Buzz in Giving of Injection
Presentation/ Reasons for Giving Injection Drug to
3 15 minutes
Discussion Patient
Presentation/
4 80 minutes Procedure of Giving Injection
Demonstration
SESSION CONTENTS
Step 1: Presentation of Session Title and Students learning tasks

(5 minutes)

NTA Level 4, Semester 1 77 Session 12: Administration of Medicine by
Injection
Step 2: Definition of Common Terms Used in Giving of Injection
(10 minutes)
TELL students to pair up and define the common terms used in giving of injection for 2
minutes.
 Injection is forcing fluid into a vessel, or cavity intramuscularly, or under the skin
 Parenteral is the route of drug administration other than digestive tract
Step 3: Reasons for Giving Injection Drug to Patient (15 minutes)
 To achieve quick therapeutic level of the drug

 To provide a route of drug administration for clients who cannot use oral route- that is an
alternative method to oral administration
 To promote client’s health and well being
Step 4: Procedure of Giving Injection (80 minutes)
Assessment
 Does the client has a hidden major medical problem or is allergic to any drug?
 Is the client currently on any other medication?
 Does client have acceptable injection sites?
Equipment
A tray containing:
 Sterile syringes
 Drugs to be administered
 Cotton wool swabs – sterile
 (5Alcohol 70%
 Client’s drug sheet
 Container for used syringes and needles
 Container for use swabs
For Intra dermal Injection

 Review drug sheet to determine drug to be given
 Assess client for any specific actions indicated before giving the drug e.g. Cardiac drugs,
Morphine etc. – Check for pulse and respiratory rate respectively
 Prepare syringe
 If ampoules snap the top, if vials clean the top of it with alcohol

Injection
 Withdraw ordered amount of the drug, remove needle and replace cover (if multiple dose
vial)
 Identify client again by calling him by his name
 Select the site for the injection and wipe it with alcohol 70% using circular motions
(inside to outside)
 Pull the skin to ensure shallow penetration of the drug just under the skin
 Hold the syringe at 10o to 15o and inject the drug. The drug will cause a wheal swelling.
Do not rub the area but just wipe off excess solution
 If a skin reaction is expected, use a ball point pen to draw a circle around the site for easy
identification and observe later
 Clear equipment
 Record medication on client’s chart
 Thank client for participation
For subcutaneous injection

 Select the site and clean with alcohol
 Bunch the tissue between your left thumb and index finger
 Hold the syringe and needle at angle 450 angle and inject. Aspirate a little to make sure
that you are not in a blood vessel, then inject the medication
 Apply pressure on the site after the needle is withdraw to prevent the medication from
flowing back through the needle track
 Clear equipment
 Record drug in client’s chart
 Thank client for co-operation
For intramuscular injection:

 Select the site and clean with alcohol
 Using your thumb and index finger of the left hand, spread the skin flat to ensure the
needle will reach far down the muscle
 Hold the needle at 90o and inject
 Pull back on the plunger to ensure that the needle is not in a blood vessel. If you obtain
blood on aspiration, remove the needle and syringe, and discard the drug. Get a new
preparation in a new syringe and use another site
 If you do not obtain blood, inject the medication slowly but firmly
 Place the alcohol swab at the base of the needle and apply pressure over the injection site
as you withdraw needle. This action will prevent the medication from flowing back
through the needle track
 Then rub the area for a few seconds to increase blood circulation and aid absorption of the
drug
 Reposition client as necessary and leave him comfortable
 Clear equipment and discard accordingly
 Record medication on client’s drug sheet
 Observe for any untoward signs and report
 Thank client for cooperation and participation

Injection
Step 5: Key points (5 minutes)
 During administering injection, angle of holding syringes and needles depends on the
types of injections administered
 Principles of administering injection should be adhered
 Which parenteral routes for administration of medications may be ordered to clients?

 What are the principles of administration medicines by injection?
References
Wilkins.
Profession.
Wilkins.

Injection
Session 13: Instillation of Eye, Ear and Application of
Ointment
Total session Time: 60 minutes
Prerequisite
 None
Learning tasks
 Define common terms used in instillation eye, ear and application of ointments
 Identify purposes for instillation
 Demonstrate the procedure for instillation eye, ear and application of ointments
Resources Needed
SESSION OVERVIEW

Presentation Session Title and of Students
Learning Tasks
Common Terms Used in Instillation and
Application of Ointments
Purposes of Installation of Eye, Ear and
3 10 minutes Buzzing/Discussion
Application of Ointments
Presentation/ Perform Procedure on Instillation of Eye,
4 30 minutes
Demonstration Ear and Application of Ointments
SESSION CONTENT


NTA Level 4, Semester 1 81 Session 13: Instillation of Eye, ear and
application of ointment
Step 2: Common Terms Used in Instillation and Application of Ointments
(5 minutes)
Introduction
 Medical that may be instilled or administered directly to the eye, ear and nasal includes
liquids medications and ointments.
 Doses of this type of drugs prescribed in the form of drops.
 A dropper is used to administer such drugs.
 Therefore, reading of manufacturer and prescriber instruction is very important for
accurate doses and safety
Common terms used

 Instillation: Is the process of slowly pouring or dropping of a liquid into a cavity or onto
a surface
 Ointment: Is a viscous, semisolid (vehicle) medium used to apply medicine to the skin
 Dropper: Is a tube usually narrowed at one end for dispensing drops of liquid
 Instillator: Is an apparatus for introducing drop by drop liquids in to a cavity
Step 3: Purposes for Installation of Eye, Ear and Application of Ointments

(10 minutes)
Activity: Small Group Discussion (10 minutes)
DIVIDE students into small manageable groups
ASK students to discuss in groups on the Purposes for installation of ear, nasal, eye, and
application of ointments for 3 minutes
AFTER small group discussion, ask students to provide their responses for 6 minutes
Purpose for Instillation of Ear Drops

 To treat infection
 To relieve local inflammation
 To soften wax
Purpose for Instillation of Nasal Drops

 To relieve nasal congestion
 To arrest nasal bleeding
Purpose for Instillation of Eye Drops and Application of Ointments

 To promote a therapeutic effect
 To relieve local inflammation
 To provide local anaesthesia
 For diagnostic purpose

Step 4: Procedure for Instillation of Eye, Ear and Application of Ointment
(30 minutes)
Procedure for Instillation of Ear Drops
Assessment:-
 Is the environment conductive?
 Is there any drainage from the ear?
 Is there any history of injury of foreign body?
Equipment:
 Prescribed drug at room temperature
 Cotton wool swabs
 Medicine dropper
 Receiver for used swabs
Steps:
 Inform client of the procedure
 Check the drug three times
 Assist client to hold his head to the side, if sitting up or lie on one side if in bed
 With one hand pull the pinna up and back to straighten the ear canal
 Using the dropper, allow the number of drops ordered to fall into the canal. Be careful not
to touch the dropper against the ear
 Allow the client to remain in this position for 3- 5 minutes to allow for penetration
 Repeat with the other ear if required
 Do not place cotton wool in the outer ear to hold back the medicine as this will draw the
medicine out of the canal. Wipe excess medicine using swabs
 Clear equipment and leave client comfortable
 Give related health education
Procedure for Instillation of Nasal Drops

Assessment:
 Is the client able to administer the drug to himself?
 Does the client’s condition allow for the treatment?
 Does the client have any history for drug reaction?
 Is there any discharge from the nostrils?
Equipment:
 Prescribed drug at room temperature
 Receiver for use swabs
 Dropper
Steps:
 Wash hands
 Identify drug by checking three times

 If client is in supine position, place a pillow under his neck to tilt the head. If sitting up
ask him to tilt his head
 Hold dropper and while tipping the tip of nose upward, allow drops to fall into nostrils as
ordered
 Instruct client to hold his head in this position for 3 – 5 minutes for absorption
 Ask client to sniff so that the drug spread to back of nasal cavity
 If the drug is in squeezer bottle, the client should be sitting upright. Tilt the head and
squeeze bottle.
o This will prevent too many drops pouring out
 If client is able to do this himself, let him do so
 Wipe any excess medication on the surrounding skin
 Leave client comfortable
 Provide health education as required
Instillation of Eye Drops and Application of Ointments

Assessment:
 Is there any injury to the eye?
 Is the client able to open the eye by himself?
 Is there any discharge?
Equipment:
 Prescribed drugs
 Bottle of sterile normal saline
 Plaster and a pair of scissors
 Receiver for dirty swabs
 Eye pad or eye shield
Procedure for Instillation of Eye Drops and Application of Ointments

 Inform client about the procedure
 Wash hands
 Carry tray to client’s bed side
 Ask him to lie in supine position. If he is sitting, ask him to tilt the head
 Inspect the eye and if any discharge, clean it using a sterile swab dipped in sterile normal
saline from inside – outwards
 Take a dry swab, place it on the skin beneath the eye, and gently retract the lower eye lid
to expose the conjunctiva
 Ask client to look up so that the cornea is away from the lower fornix
 Use a sterile dropper and allow the required number of drops to fall into the lower fornix
 Instruct the client to close eye gently and blink gently to allow medication to spread over
the eye surface. Eye drops should be at room temperature for client’s comfort
 Do not touch the eye with the dropper to avoid contamination
 Discard any unused medication draw up into the dropper
 For ointments, unscrew the cap of tube and put it on the table inner side facing up to keep
it clean
 Squeeze a drop onto the gauze for precaution in case it was contaminated before
 Expose the conjunctiva as above and place a rim of ointment along the sac from inside
outwards
 Instruct client to close and blink the eye to allow spread of the ointment
 Squeeze another drop out and replace cap
 Wipe off any extra medication from the skin around the eye
 Pad the eye if indicated
 Clear equipment and leave client comfortable
 If both drops and ointments are prescribed for one eye ear or nose, start with drops to
prevent them slipping off over the ointment followed by the ointment
 In case of eye drops, instruct client to close the eye gently and blink gently to allow
medication to spread over the eye surface.
 Eye drops should be at room temperature for client’s comfort
 Do not touch the eye, ear, or nose with the dropper to avoid contamination
 Wipe excess medicine using swabs
 In case of nasal drops instruct client to hold his head in this position for 3 – 5 minutes for
absorption and ask him to sniff so that the drug spread to back of nasal cavity
 What are the difference between eye, ear and nasal ointment and drops?
 What is the importance of using the drops at room temperature?
 Identify instructions given to the client after instilling the eye, ear and nasal ointment
 Explain the preparations should be done before carrying out the procedure
 Explain how to position the client when instilling eye, ear or nasal drops
References
Wilkins.
Profession.
Wilkins.

Session 14: Topical Administration of Medicines
Prerequisites
 None

 Define a term topical administration
 Identify the purpose of topical administration of medicine
 Demonstrate the procedure of topical administration of medicine
Resources Needed
SESSION OVERVIEW

Tasks
Definition of a Term Topical
Administration
Presentation/ Purpose for Topical Administration of
3 5 minutes
Brainstorm Medicine
Presentation/ Procedure for Topical Administration of
4 15 minutes
Demonstration Medicine
Step 1: Presentation of Session Title and Learning Task (5 minutes)

NTA Level 4, Semester 1 86 Session 14: Topical Administration of
Medicines
Step 2: Purpose for Topical Administration of Medication (5 minutes)
Activity: Brainstorming (2minutes)
ASK the students to brainstorm on definition and purpose for topical administration of
medicine for 2 minutes
Definition
Topical administration
 To apply a drug locally to the skin or to the site e.g. eye, ear or nose
 To provide antiseptic and ant parasitic treatment
 To soothe and soften the skin
 To provide therapeutic requirements for skin conditions
 To prevent itching
Step3: Topical Administration of Medicines (15 minutes)
Assessment
 What is the general condition of the client?
 Is it appropriate for the procedures?
 Is the client able to perform the procedure himself?
Equipment
 Spatula
 The prescribed drug
 Gloves – clean if skin is intact – sterile if skin is broken
 Gauze swab – sterile if is broken
 Bed cradle
Steps
 Wash hands
 Ask client to wash off old layer of medication if he is able. If unable wash the area for
him
 Check the medication three times like any other medications
 Use a spatula to remove the required amount of the drug and place it on the gauze swab
 If the drug is in a tube, squeeze a reasonable amount onto the gauze swab
 Use the spatula or gauze swab and spread the drug over the affected area. Do not spread
topical medicine with your bare fingers as it is absorbed into the skin
 Use sterile gloves and sterile gauze if the skin is broken
 Provide a bed cradle to prevent the drug from rubbing against the bed clothes
 Give health education accordingly
 Return equipment and leave client comfortable
Medicines
 Check the medication three times like any other medications

 Use the spatula or gauze swab and spread the drug over the affected area. Do not spread
topical medicine with your bare fingers as it is absorbed into the skin
 How you will assess the effectiveness of the drug?

 Why is not recommended to use your bare fingers to spread topical medication?
References
Wilkins.
Profession.
Wilkins.

Medicines
Session 15: Insertion of Suppositories
Prerequisite
Learning Tasks
By the end of this session, students will be able to:
 Define common terms used in insertion of suppositories
 State the purpose for insertion of suppositories
 Demonstrate procedures for insertion of vaginal and rectal suppositories
Resources Needed
 Illustration Charts
SESSION OVERVIEW

Presentation of Session Title Session and
Common Terms Used in Insertion of
Suppositories
Buzzing/
3 15 minutes Purpose for Insertion of Suppositories
Discussion
Presentation/ Procedures for Insertion of Vaginal and
4 25 minutes
Demonstration Rectal Suppositories
SESSION CONTENT
Step 1: Presentation of Session Title and Students learning tasks (5

minutes)

NTA Level 4, Semester 1
89
Step 2: Introduction (5 minutes)
 Suppositories are drugs acting in various ways, including softening the faces, releasing
gases or stimulation of the nerve ending in the rectal mucosal.
 It also used as treatment and prevention of infections in the intended sites.
 For effectiveness suppositories need to be inserted beyond the internal anal sphincter and
should remains for 30 minutes before it expelled through defecation or urination
 Suppositories: Is a semisolid substance for introduction into the rectum, vagina or
urethral where it dissolve.
 Is often served as a media (vehicle) for medicine to be absorbed.
Step 3: Purpose for Insertion of Suppositories (15 minutes)

ASK students list the purpose for insertion of suppositories
 To combat local infection

 To provide an alternative route for medication when there is malfunctioning of the upper
gastrointestinal tract as in severe vomiting
 To offer an alternative route when a drug has bad taste or offensive odor
 To maintain chemical integrity of a drug when the digestive enzymes change its chemical
properties
 To provide local therapeutic effect
 To relieve pain and provide analgesic effects
Step 4: Insertion of Suppositories (25 minutes)
Procedure for Insertion of Vaginal Suppositories

Assessment:
 What is the client’s ability for self-care?
 Is the environment conducive for the procedure?
 How much discharge does the client have?
 Is there any pain or itching?
Equipment:
Small tray containing:-
 Prescribed suppository
 Gauze swabs – sterile
 Warm water in galipot
 Sanitary pad
 Pair of gloves

90
Steps:
 Wash hands
 Assess client for ability to self-care
 Screen bed for privacy
 Put on gloves for self-protection
 If client is not able to perform self-care, assist her to a supine position with knees flexed
and thighs apart to expose the vulva
 Clean vulva and vaginal orifice with clean water and cotton wool swabs (client can wash
herself in the bathroom if condition allows). Clean vulva from moving towards the anus
and use each swab once to prevent spread of micro-organisms
 Insert the suppository into its applicator making sure not to touch any portion hat will
enter vagina
 Lubricate tip of the suppository with sterile lubricant (discard first drop of lubricant for
sterility purpose). Water may be used instead of lubricant
 Spread the vulva to expose vaginal orifice with one hand, and with the other hand insert
the applicator directing it downward towards the client’s back
 Push in the plunger to insert the suppository
 Remove the applicator the vaginal orifice with a gauze swab
 Instruct client to lie flat on her back for 15 minutes to prevent expulsion of the
suppository
 If the drug is a form of cream, fill the applicator with the amount prescribed, insert the
applicator gently in to vaginal and press down on the plunger to expel the content.
Remove applicator, and wipe the vulva as above
 Place sanitary pad temporarily to prevent staining of client’s underwear. Cover client and
leave her comfortable
 Clear and clean equipment
 Record medication on client’s chart.
 Remove screens
Procedure for Insertion of rectal Suppositories

Assessment:
 Is there any special precaution to be taken?
 Is there any visible abnormality?
Equipment:
 Prescribed suppository
 Pair of gloves
 Warm water in a galipot
Steps
 Screen the bed for privacy
 Assist client to lie in left lateral position
 Fold top bed linen to expose buttocks

91
 Put on gloves
 Remove covering of the suppository and dip the tip in warm water
 Instruct client to breath through the mouth during insertion
 Separate the buttocks to expose the anus and gently insert the suppository (by the
lubricated end) the full length of your finger. This ensures that the suppository is beyond
the first and second rectal sphincters
 Withdraw your finger gently and press the client’s buttocks together for full minute to
prevent the sensation of bowel movement caused by rectal intrusion
 If it is an evacuant suppository, ask client to retain for 15 to 30 minutes
 If it was for medication purpose, instruct client to retain as long as he can before opening
bowels
 Replace bed linen as necessary and remove screens
 Make client comfortable and clear equipment
 Bring a bedpan or commode to the bedside if client is unable to go to the toilet
 Record procedure in the client’s chart
 Observe the results and write a report

 In hot weather keep suppositories in a refrigerator so that they can remain firm
 If the client is to have this treatment over a period of time, instruct him clearly on self
administration and positioning if his condition allows
 Ensure adequate privacy

 What are the equipment will you prepare for insertion of vagina or rectal suppository?
 What are the assessments are you going to make before and after administering the
vaginal or rectal suppository?
References
Wilkins.
Profession.
Wilkins.

92
Session 16: Administration of Oxygen
Prerequisite
Learning tasks
 Define Common terms used in administration oxygen
 Identify the purposes for administering oxygen
 Demonstrate the procedure of oxygen administration
Resources Needed
SESSION OVERVIEW

Presentation of Session and Title Learning
Tasks
Common Terms Used in Administration
Oxygen
Buzz/
3 15 minutes Purposes for Administering Oxygen
Discussion
Presentation/ Perform Procedure on Administration of
4 25 minutes
Demonstration Oxygen
SESSION CONTENT


93
Step 2: Common terms Used in Administration of Oxygen (5 minutes)
 Oxygen therapy: Is the administration of oxygen at higher levels than anomaly found in
the atmosphere to patient needing enhanced tissue oxygen uptake
 Nebulizer: Is an apparatus for producing a fine spray
 Oxygen cylinder (tank): is the container which preserves the oxygen
Step3: Purpose for Administration Oxygen (15 minutes)
Activity: Small Group Discussion (5minutes)
ASK students to discuss in groups on purpose of oxygen administration 4 minutes
 In hypoxia (decreased oxygen level in the body cell)

 In hypoxemia (decreased oxygen level in the blood)
 To sustain life in emergencies where clients are cyanotic and gasping for air
Step 4: Procedure on Administration of Oxygen (25 minutes)
Assessment:
 What is the client’s general condition?
 Which is the best method to administer oxygen to the client?
 Is the environment conductive for the procedure
Equipment:
 Oxygen cylinder (tank) or by wall outlets from a centralized system
 A wing bolt for screwing opening the cylinder
 A pressure gauge
 A control valve
 Flow meter
 Oxygen key
 Mask
 Nasal cannula and tubing
 Humidifier with distilled water and rubber tubing
 Orange sticks with Cotton wool swabs
 A “NO SMOKING” label
 Glycerin
 Emergency tray

94
Steps:
 Inform patient about the procedure in order to gain cooperation
 If oxygen is to be administered by a wall outlet, screw the flow meter into the outlet in the
wall then open the valve.
 A mercury ball will rise in the flow meter to indicate how much oxygen is flowing
 Attach the tubing from the flow meter to the container with sterile distilled water for
humidification
 Another tubing levels the humidifier and connects to the client either by mask, nasal
prongs or T-tube
 If using oxygen cylinder (tank), keep it away from client. Screw the flow meter onto the
cylinder, ensure that it fits well
 Close control valve on the flow meter
 Turn oxygen on by rotating the central square bolt using the oxygen key and turning
towards the direction of the arrow. Turn gently little by little.
 When loose, attach one end of the rubber tubing on the flow meter and connect the other
end to the humidifier (attached to the flow meter)
 Connect second rubber tubing one end to the humidifier and the other end to the mask
 Release control valve to ensure that the system is running on smoothly and oxygen is
bubbling through the distilled water at low rate. Place a “NO SMOKING” signboard at
entry into the room
 Take the cylinder to client’s bedside, and explain to him what you want to do
 Clean his nostrils with cotton wool swabs and orange sticks if necessary
 Lubricate prongs with water insert them into both nostrils and place the tubing over his
ears. Fix well at the back of the head
 Using the control valve, now turn on the oxygen to the prescribed flow rate.
 If by face mask, turn on the oxygen at low rate as above
 Place the mask to fit properly and cover both the nose and mouth. It is important that it
fits tightly to prevent oxygen escaping around it. The mask connects directly to the
oxygen supply tubing from the humidifier
 When mask is well fitted, turn on the oxygen to the prescribed flow rate. If by T-tube to
the endotracheal or tracheostomy tube. Connect one arm of the T-tube to source of
oxygen nebulizer and leave the other arm open to the atmosphere ( a nebulizer provides
warmth and humidity to the oxygen)
 If using a tracheostomy mask, fit the mask well over the tracheostomy tube and continue
as above
 Apply Glycerin to client’s lips if dry
Step 5: Key points: (5minutes)
 Put a “NO SMOKING” signboard at entry into the room

 Never place oxygen delivery equipment on a client before testing (turning on the Oxygen
at low rate). This will prevent sudden oxygen surge or aspiration of water in the tubing.
 Substitute nasal prongs for mask when client is eating or drinking

95
 What are the reasons for putting a “NO SMOKING” on the signboard at entry into the
room?
 What are the methods for administration of oxygen?
References
Wilkins.
Profession.
Wilkins.

96
Session 17: Bed Bathing of an Adult Patient
Prerequisite
 None
Resources needed
SESSION OVERVIEW

Tasks
2 5 minutes Presentation Common Terms Used in Bathing a Patient
Buzzing/
3 10 minutes Purpose for Bathing an Adult Patient
Discussion
Presentation/ Perform Procedure for Bathing an Adult
4 30 minutes
Demonstration Patient
SESSION CONTENT

READ/ASK students to read the students learning tasks and clarify.
Step 2: Common Terms Used in Bathing a Patient (5 minutes)
 Bed bathing is a very useful opportunity for both the client and the nurse.
 The nurse can closely observe the client and establish friendly communication with him.
 The client can use this time to express his feelings or worried and perhaps ask questions
and seek reassurance.
 If the client is able to wash himself he should be allowed to do as much as possible and be
assisted where appropriate
Definition
 Bed bathing: Giving a patient a bath while in bed

97
Step3: Purpose for Bathing a Patient (10 minutes)
Purposes
 To provide body hygiene and comfort
 To relieve skin irritation and promote relaxation
 To encourage blood circulation
 To reduce body temperature in case of fever
 To promote self-esteem through improved physical appearance
Step4: Procedure for Bed Bathing an Adult Client (30 minutes)

Assessment:
 Does the general condition of the client allow for the bath?
 Is the client ready for the procedure?
 How much can he do by himself in this procedure?
Equipment:
Top shelf:
 Two basins dish two flannels
 two towels
 comb
 soap in a soap
 Vaseline or body lotion
 Pair of gloves
Bottom Shelf:
 Bed linen- sheets, blankets, pillow cases and draw sheets
 Draw Mackintosh
 Bucket for used water
 Linen bag for dirty linen
 Chair or stool at the foot of the bed
Steps for bed bathing an adult client

 One nurse may wash the client but if he is helpless two nurses are required
o If the client is able to wash himself, put all required equipment within reach and
screen the bed
 Leave him to wash himself and when he is through assist him with areas where he could
not reach

98
For the helpless client:
 Bring the trolley to the client’s bedside
 Close the curtain or the door and screen the bed
 Loose the linen, remove the sheets and leave the client with one blanket
 Put clean linen on the chair and dirty ones in the linen bag
 Reduce pillows and leave the client with only one pillow under his head for comfort
 Put water in the basins and test temperature using your elbow (should be at body
temperature)
 Place the draw Mackintosh and towel under the client’s head to protect the pillow and
bottom sheet
 Ask the client if he likes soap on his face
 Wash his face, paying attention to the eyes and ears. Rinse well and dry
 Put towel under the client’s arm farther from you
 Wash with soap flannel, rinse and dry
 Wash the nearest arm in the same manner
 Wash chest and abdomen, paying attention to the umbilicus and under the breasts (in
females)
 Rinse and dry
 Cover the client and change water
 Expose the leg farthest from you, put towel under it, wash with soapy flannel, rinse and
dry
 Proceed with the leg nearest to you in the same manner
 Turn the client to his side his back towards you, place towel on the bed surface to protect
bottom sheet
 Wash the back from neck to buttocks, rinse and dry. Observe for any signs of pressure
sores.
 Turn client on his back, put towel under his buttocks, wash the genital region, rinse and
dry
 Remake the bed, changing the bed linen as necessary. Replace the pillows
 Apply body lotion
 Put on his bed wear
 Comb his hair and make him comfortable
 Thank the patient
 Clear equipment, remove screens and open windows
 Record and report any abnormalities observed
 Use gloves for self-protection if client has discharging lesions or is soiled with urine or
stools
 Bathing is an excellent time to perform a complete skin assessment
 Bathing provides time to educate the client on basic and special hygienic needs

99
 What equipment to be prepared for bathing a helpless client?

 What are the categories of bathing a patient?
References
Wilkins.
Profession.
Wilkins.

100
Session 18: Washing a Patient’s Hair in Bed
Prerequisite
 None
Learning tasks
 Define common terms used in washing patient’s hair
 Outline the reasons for washing patient’s hair
 Demonstrate the procedure for washing patient’s hair in bed
Resources needed
SESSION OVERVIEW TABLE

1 Presentation off Session Title and Learning
5 minutes Presentation
Tasks
Brainstorm/
2 10 minutes Reasons for Washing Patient’s Hair
Presentation
35 minutes Presentation/ Demonstrate the Procedure For Washing
3
Demonstration Patient’s Hair in Bed
SESSION CONTENT


101
Step 2: Reasons for Washing a Patient’s Hair (10 minutes)
 With women hair washing may be once or twice a week.
ASK students to discuss in groups on the reasons for washing patient’s hair
Reasons:
 To maintain personal hygiene
 To stimulate circulation to scalp
 To promote self- esteem by enhancing physical appearance
 To eradicate pediculosis infestations
Step 4: Washing a Patient’s Hair in Bed (35 minutes)
Assessment:
 Is it appropriate to carry out the procedure?
 Is the environment conducive?
 Is there any extra equipment needed for the procedure?
Equipment:
 A jug of warm water
 2 bath towels – 2
 2 mackintosh – 1 floor Mackintosh – 1 draw Mackintosh
 Soap of Shampoo in a soap dish
 Basin
 Comb
 Personal belongings for hair styling
 Bucket for used water
 Pint measure
Steps:
 Inform client about the procedure and screen the bed for privacy
 Remove pillows and top bed linen, leave the top sheet
 Pull the mattress towards the bottom end of the bed leaving the wire springs expose at the
top
 Put Mackintosh and towel at the top of the bed to protect bed linen
 Place floor Mackintosh on the floor beneath the bucket
 Assist client to move towards top end of bed so that his head is close to the edge of bed
 Pour warm water into the basin
 Using the pint measure, take water from the basin, pour on client’s head to wet hair

102
 Apply soap or shampoo, measure well
 Pour water from pint measure to rinse hair, taking care that water runs into the bucket.
 Repeat soap or shampoo application if hair is exceptionally dirty
 Dry hair thoroughly using the bath towel
 Remove protective Mackintosh from the bed and replace mattress in proper position
 Assist client to comb hair in the desired style
 Change any soiled linen, remake the bed and make client comfortable
 Clear equipment, clean and return to appropriate place
Step6: Key Points (5 minutes)
 Condition of the patient should be considered prior to the procedure

 Pull the mattress towards the bottom end of the bed leaving the wire springs expose at the
top
 Assist client to move towards top end of bed so that his head is close to the edge of bed
 How often should you wash client’s hair?

 What are the techniques of washing patient’s hair?
References
Wilkins.
Profession.
Wilkins.

103
Session 19: Mouth Care of an Unconscious Patient
Total Session Hours: 60 minutes
Prerequisite
 None

 Define terms used in mouth care
 Outline the purposes for mouth care
 Demonstrate mouth wash for an unconscious patient
Resources Needed
SESSION OVERVIEW

Tasks
2 5 minutes Presentation Common Terms Used in Mouth Care
Presentation/Buzzing/
3 10 minutes Purposes for Mouth Wash
Discussion
Presentation/ Demonstrate Mouth Wash for an
4 30 minutes
Demonstration Unconscious Patient
SESSION CONTENT
Step 1: Presentation of Session Title and Learning tasks (5 minutes)


NTA Level 4, Semester 1 104 Session 19: Mouth Care of an Unconscious
Patient
Step 2: Common Terms Used in Mouth Care (5 minutes)
 Oral hygiene: Is providing cleanliness of the teeth and other structure in the mouth
 Cavities: dental carries
 Dental Plaque: Is a gummy mass of microorganisms that grows on the crowns and
spreads along the root of the teeth, may result into periodontal disease
 Pyorrhea: Periodontal disease
 Gingivitis: Inflammation of the gum
 Stomatitis: Inflammation of the oral mucosa
 Halitosis: Is offensive breath (bad breath)
Step 3: Purposes for mouth wash (10 minutes)
Purpose:
 To provide cleanliness of mouth and teeth
 To prevent dental decay and infections
 To stimulate circulation to oral tissue
 To keep oral mucosa moist
 To promote client’s comfort and prevent halitosis
Step 4: Perform Mouth Wash for an Unconscious Patient (30 minutes)
Assessment:
 What is the general condition of the patient?
 Is the environment conducive?
Equipment:
 Mouth wash solution e.g. sodium bicarbonate teaspoonful to 1 pint of water in galipot
 Hydrogen peroxide 1% if mouth is very dirty
 Potassium permanganate solution
 Toothpaste
 Toothbrush or padded tongue depressor – padded with gauze swab and secured with
plaster
 Gloves
 Glycerin with borax or Vaseline for lip care
 Gauze swabs in a container
 Mackintosh and towel
 Mouth gauge for opening the mouth

Patient
Steps:
 Inform the patient about the procedure
 Wash hands and put on gloves
 Position back of head on a pillow so that face tips downwards. This will allow fluid to
flow out of the mouth. Client lies head turned to the side
 Place towel and Mackintosh under the client’s head and chin to protect bed linen
 Apply some toothpaste on toothbrush or moisten padded tongue depressor in mouth
solution
 Wash surface of teeth, between cheeks and gums, roof of mouth, the tongue and lips
 Rinse mouth with sodium bicarbonate, changing the gauze swabs as necessary
 Hydrogen peroxide is used instead of sodium bicarbonate in a very dirty mouth
 Apply Glycerin or Vaseline to lips if they are dry or cracking
 Clear and clean equipment and return to proper place
 Remove screen and leave client comfortable lying on the side
 Never put fingers in the mouth of an unconscious client as he/she may develop muscle
spasms and bite them
 Position patient in such a way that the back of head is on a pillow so that face tips
downwards. This will allow fluid to flow out of the mouth to prevent aspiration
 Daily oral care is essential to maintain the integrity of the mucous membranes, teeth,
gums and lips
 Poor oral hygiene may affect client’s social interactions and nutritional intake
 How will you position an unconscious patient for mouth wash?

 What are the complications associated with poor oral hygiene?
 What are the equipment needed for mouth wash for an unconscious patient?

Patient
References
Wilkins.
Profession.
Wilkins.

Patient
Session 20: Assisting a Helpless Conscious Patient with
Oral Care
Prerequisite
 None
Learning tasks
 Define common terms used in Oral care
 Outline the purpose for oral care
 Demonstrate mouth care for a conscious helpless patient
Resources
SESSION OVERVIEW

Tasks
2 5 minutes Presentation Common Terms Used in Oral Care
Buzzing/
3 10 minutes Purpose for Oral Care
Discussion
Presentation/
4 30 minutes Mouth Care for a Conscious Helpless Patient
Demonstration
6 5minutes Presentation Evaluation
SESSION CONTENT

NTA Level 4, Semester 1 108 Session 20: Assisting a Helpless Conscious
Patient with Oral Care
Step 2: Common Terms used in Oral Care (5 minutes)
 Oral care is an important aspect of care for all persons, in order to maintain health teeth
and prevent infections and halitosis.
 Sick people may be unable to reach for supplies, so nurse should incorporate his aspect
into their day to day care of the client
Definitions
 Conscious patient: A patient who is aware and has perceptions (awake)
 Helpless patient: A patient who is dependent on an outside source for life support
(unable patient)
Step 3: Purpose for Oral Care (10 minutes)

ASK students list the purpose for oral care
Purposes
 To promote clean teeth and mouth
 To prevent dental caries infection and halitosis
 To promote circulation to oral tissue
 To promote self – esteem and improve physical appearance
 To prevent dental caries infection and halitosis
 To promote circulation to oral tissue
 To promote appetite
Step 4: Perform Mouth Care for a Conscious Helpless Patient (30 minutes)
Assessment:
 Is the time appropriate for the procedure?
 How much help will the client need?
 Does the client have a toothbrush and toothpaste?
 Does client have To promote clean teeth and mouth
 Is the time appropriate for the procedure?
 Is normal teeth or denture?
Equipment:
 Toothbrush and toothpaste
 Clean water in a glass
 Receiver
 Towel
 Vaseline of Glycerin
 Mouthwash if desired

Steps:
 Assist client in a sitting position by elevating head of bed
 Cover his chest and neck with towel
 Wet toothbrush with water, place toothpaste on it and hand it to him
 Assist him as the cleans all surface of teeth outside, inside, top and bottom
 Offer toothpicks if desired
 Offer clean water for rinsing the mouth
 Apply Vaseline or Glycerin to lips if they are dry
 Remove screens
 Clear and clean equipment and return to client’s locker
 Encourage the patient to perform the cleaning as much as he/she could, only assist when
necessary
 Teach the patient on the appropriate techniques for cleaning teeth
 What health education will you plan to the client?

 Why is it important to clean teeth after each meal?
 What is the equipment required for mouth wash for helpless patient?

References
Wilkins.
Profession.
Wilkins.
Sorenson, K., & Luckman, J. (1994) Basic nursing: A psychophysiologic approach (3rd ed.).
St. Louis: W. B. Saunders.

Session 21: Care of a Patient with Wounds
Prerequisite
Learning tasks
 Define common terms used in wound care
 Outline the purpose of wound care/Dressing
 Explain the principles of sterile technique
 Demonstrate the techniques of wound dressing
Resources Needed
SESSION OVERVIEW

1 5 minute Presentation
Common Terms Used in Wound
Care
3 10 minutes Presentation, Group Discussion Purpose of Wound Care/Dressing
4 10 minute Presentation Principles of Sterile Technique
5 80 minutes Presentation & Demonstration Procedure for Wound Dressing
SESSION CONTENT


112
Step 2: Common Terms Used in Wound Care (5 minutes)
 Application of dressings to a wound is one of the nurses’ responsibilities in order to

enhance wound healing.
 A wound is a break in the skin surface which may result from accident injuries or by
prolonged pressure over a body part.
 It may also be surgically created or self inflicted.
 Whatever the source of the wound, appropriate care must be given to promote healing and
prevent complications.
 Aseptic technique should always be applied.
Definitions
 Wound: Disruption in the normal integrity and function of the skin and underlying
tissues. Or is a break in the continuity of soft part of the body structures caused by
violence or trauma to tissues
 Asepsis: Sterile, a condition free from gems, infection, and any form of life.
 Aseptic: Free from septic matter
 Aseptic techniques: method used to prevent contamination in procedures where a sterile
field is required
 Sterilization: Is a process of completely removing or destroying all microorganism on a
substance by exposure to chemical or physical agents, exposure to ionizing radiation, or
by filtering gas or liquids through porous material that remove micro organisms.
 Decontamination: is the process of killing microorganisms except spores.
 Dressing: Covering, protective or supportive, for diseased or injured part
Step 3: Purpose of Wound dressing (10 minutes)
ASK students to discuss in groups on purposes of wound dressing
Purposes:
 To protect wound from micro organisms
 To absorb exudates
 To immobilize and support an injured part
 To reduce tension on the edges of the wound
 To apply pressure on the wound and prevent bleeding
 To promote psychological and physical comfort to toe client by minimizing moisture and
bad smell
 To enhance healing
 To provide opportunity for wound inspection

113
Step 4: Principles of Wound Dressing (10 minutes)
 These are basic rules considered during performing sterile procedures.

 They include;
o Strictly adherence to the aseptic techniques to minimize the potential contaminations
and prevent infection
o Use non touch technique, sterile material in a sterile field to provide a barrier to
restrict the transfer of micro-organisms
o If there is any doubt about the sterility of an item, it must be considered unsterile
o The possibility of contamination increases with time, therefore the sterile field should
be established as close to the time of use as possible
Step 5: Techniques of Wound Dressing (80 minutes)
Assessment:
 Assess the client’s general comfort
 Check the condition of the wound and the size of the dressing
 Determine special or additional equipment will be needed e.g. presence of drain in a
wound
Equipment:
Top shelf: Sterile equipment
 Dressing towels
 2 non toothed dissecting forceps
 2 dressing forceps
 2 galipot
 Gauze swabs
 Pair of scissors
 Sterile Gloves
Bottom shelf:
 Plastic paper bag or receiver
 Bottle of antiseptic solution
 Receiver for used instruments
 Clean dressing mackintosh and towel
 Drum or pack with extra gauze swabs
 Adhesive plasters and bandages
 Cheatle forceps in a jar
 Hand rub
Steps:
 Close the nearby windows
 Bring trolley to the patient’s bedside
 Position patient comfortably and remove the bedclothes to expose old dressings
 Place dressing mackintosh and towel under the area to protect bottom sheet
 Wash hands and dry/use hand rub
 Open the dressing pack, and create a sterile working field by spreading the sterile towel
under the dressing site

114
 Arrange equipment on the trolley in order, using a dissecting forceps. Put enough gauze
swabs
 Pour appropriate antiseptic into the galipot, Do not touch the sterile area with unsterile
material
 Remove old dressing by loosening the adhesive tapes gently, if dressings are sticky, wet
them with normal saline for easy removal
 Discard forceps into the receiver at the bottom of the shelf
 Observe condition of the wound
 If drains are present, remove the inner dressing layer by layer to avoid pulling the drain
 Wash hands again and put on sterile gloves if necessary
 If drains need shortening, cut the stitch between the drain and the skin before pulling (if
first shortening)
 Use a sterile forceps to pull the drain and a sterile pair of scissors to cut it. Replace a
sterile safety pin to hold the drain in position
 Dip a gauze swab into the cleaning solution, using a dressing forceps. Clean the wound
from centre outward to wash away exudates from the wound. Use one gauze swab at one
stroke only once. One forceps to be used for picking sterile swabs and the one for
cleaning the wound.
 When the wound is clean apply sterile gauze swabs as required. If drains are present place
gauze swab under each one so that the rubber drains do not rest directly on the skin
surface and cause excoriation
 Secure dressings by pieces of adhesive plaster. Make sure the dressings are appropriately
secured so that entrance of micro organisms into the wound is minimized
 Replace patient’s bed clothes and make him comfortable
 Thank the patient, remove screen
 Clear, decontaminate and clean equipment as appropriate
 Wash hands, dry and record the procedure with observed findings in the patient’s chart
 Take basic medication safety when using antiseptics solutions for wound cleaning and
dressing. Read patient’s file to determine the correct prescribed drugs. Read medicine
container three time to make sure the correct drug is used
 If the wound has stitches, do not use cotton wool swabs for cleaning because they tear
against the rough edges of sutures and leave wasps of cotton in the wound.
 Always clean the wound from the centre outward to avoid carrying micro organisms into
the wound
 Observe the condition of the wound every time you perform the dressing
 Avoid talking over the open wound
 What health education does the patient need?

 What are the common antiseptics used in cleaning a wound?
 Explain the process of cleaning the instrument after procedure

115
References
Wilkins.
Profession.
Wilkins.

116
Session 22: Removing Sutures/Clips
Prerequisites
 None
Learning Tasks
 Identify the common terms used in stitch /clip removal
 Explain the purpose for removing stitches/clips
 Demonstrate the procedure for removing stitches/clips
Resources Needed
SESSION OVERVIEW

Tasks
Definition of Common Terms Used in
Stitch/Clip Removal
Presentation/
3 10 minutes Purpose for Removing Stitches/Clips
Buzz
Presentation/
4 30 minutes Procedure for Removing Stitches/Clips
Demonstration

READ or ASK Students to read the learning tasks and clarify

117
Session 22: Removing Sutues/Clips
Step 2: Common Terms Used in Stitch/Clip Removal (5 minutes)
 Sutures: Threads, wires or other material used in the operation for stitching parts of the
body together
 Stitches: Are loop of suture materials passed through skin or fresh by a needle to
facilitate healing of a wound
 Clips: Are metallic instrument for holding tissue or other material together
 Absorbable sutures: are sutures which are absorbed in the body and thus do not need to
be removed
 Non absorbable sutures: are sutures which are not absorbed and therefore require to be
removed
Step 3: Purpose for Removing Stitches/Clips (10 minutes)
TELL students to pair up and mention the purpose for removing stitches/clips for 2
minutes
 To prevent inflammation due to body reaction to the suture material

 To prevention infection due to over stay
 To provide client with psychological feeling of being well again
Step 4: Procedure for Removing Sutures/Clips (30 minutes)
Assessment
 Check if the status of the wound allow for the sutures to be removed
 Assess if it is the appropriate period for the procedure
 Check for the kind of sutures applied
 Identify specific instructions to be taken after removal of the stitches
Equipment:
Trolley- top shelf
 Sterile suture removal set
Bottom shelf
 Extra pack of gauze swabs
 A bottle of antiseptic solution or normal saline
 Plastic bag for used swabs or a receiver
 Sterile gloves
Steps:
 Position patient comfortably, remove bed clothes to expose the incision site
 Wash hands and dry,

118
 Put on gloves
 Provide a flat dry area on which to open the suture set
 Loosen the adhesive plaster, and remove top dressings. If dressings are sticky, pour some
normal saline or antiseptic solution, wait for a while then lift dressings
 Pour some antiseptic solution in a sterile galipot, dip a gauze swab in it and clean the
wound from the inside outwards
 Place a gauze swab next to the incision
 Inform the patient that on pulling the stitches he will feel a faint stinging sensation
 Hold a non toothed dissecting forceps in your left hand and a stitch scissors in your right
hand
 Use the forceps to lift the stitch notch clear off the skin, cut it as close to the skin as
possible, and pull it away from the wound. You may need to remove alternative suture the
first day, and complete the rest the next day depending on the surgeon’s order.
 After removal of the sutures, apply a sterile dry gauze swab and secure with adhesive
plaster
 If clip have been used, use a clip remover by pushing one blade of the remover at the skin
level beneath the clip and closing the second blade on it, the clip will come out
 Record the condition of the wound, and stitch removal on patient’s chart
 Replace patient’s bed clothes and keep him comfortable
 Thank the patient
 Remove screen, remove and clean equipment ready for sterilization
 If a client is discharged before sutures are removed, offer adequate information on where
and when to have the sutures removed
 If, on suture removing the wound shows signs of gaping, stop the procedure and report
immediately or seek assistance from your senior
 Why is it important to observe the patient’s physical and psychological status after the
procedure?
 What is contained in the sterile suture removal set?
 What is the indication for metal or clip sutures?

119
References
Wilkins.
Profession.
Wilkins.

120
Session 23: Giving and Removing Bedpans and Urinals
Prerequisite
 None
Learning Tasks
 Define Common terms used in giving and removal of bed pans and urinals
 Explain the procedure for giving of bedpans ad urinals
 Demonstrate how to Give and remove bed pans and urinals
Resources Needed
SESSION OVERVIEW

Learning Tasks
Common Terms Used in Giving and
2 15 minutes Buzz/Presentation
Removal of Bed Pans and Urinals
Presentation/ Demonstrate Giving and Removing
3 30 minutes
Demonstration Bedpans and Urinals
SESSION CONTENT

NTA Level 4, Semester 1 121 Session 23: Giving and Removing Bedpans
and Urinals
Step 2: Common Terms Used in Giving and Removal of Bedpans and
Urinals (15 minutes)
 Bed pans and urinal are provided to bedridden patients.
Definitions
 Bed pan: a pan shaped device placed under a bed ridden patient for collecting faecal and
urinary excreta
 Urinal: a container into which one urinates
 Urine: the fluid excreted by the kidneys, stored in the bladder, and discharged, through
the urethra
 Bed ridden: Unable or unwilling to leave the bed
 Faeces/stool: waste matter discharged from the bowels
Step 3: Procedure for Giving and Removing Bedpans and Urinals

(10 minutes)
Purpose:
 To assist in elimination for a patient who cannot use the toilet
 To obtain a stool or urine specimen
 To assess bowel and bladder actions
Assessment:
 Check if the environment conducive for the procedure
 Determine how much can the patient perform self care and if the patient be left alone
during elimination and collect the bedpan/urinal after he has finished
 Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment,
traction, or any other devices that could interfere with the patient’s ability to help with
procedure or that could become dislodged.
Equipment:
A trolley with:
 Bedpan or urinal with cover
 Toilet tissue
 Pair of clean gloves
 Warm water for hand washing
 Soap and towel
 Water for rinsing the perineum (as necessary)
 Additional PPE, as indicated (apron, face mask)
 Stool/chair for placing the bedpan/urinal before and after use

and Urinals
Steps:
 Explain clearly about the procedure to the patient
 Wash hands, dry, put on gloves
 Prepare the necessary requirements
 Raise the head of bed slightly if the patient’s condition permits
 Fold back the top linen, and remove the patient’s pajamas/gown
 If the patient is able, ask him to flex his knees and rest his weight on his heels and both
hands on the bed to lift his buttocks off the bed
 Slide the bedpan under the buttocks. Buttocks to rest on the rounded surface of the
bedpan and the narrow end faces the foot of the bed
 If the patient is too weak to raise himself, roll the patient to the side away from you, place
bedpan against his buttocks and roll him onto his back with the bedpan in position.
 Offer him a urinal to place for himself. If he cannot, place it in position for him.
 Leave the patient alone for some time, but if he is too ill remain with him and assist
 Remove the urinal when ready, cover it and place it on the trolley or stool
 Assist in cleaning his perineal area using the toilet paper or clean water accordingly
 Help the patient to lift up and remove the bedpan
 Cover the bedpan and send it to the sluice room together with the urinal
 Offer patient water and soap to wash hands, give towel to dry hands
 Change draw sheet if necessary
 Position the patient to a comfortable position, and replace the top bed linen
 Spray or apply air refresher if available and necessary
 Remove the screen and open windows for fresh air
 Go to the sluice room to assess the stool and urine for any abnormalities
 Measure the amount of urine, take specimen if indicated
 Empty both bedpan and urinal, rinse and clean thoroughly before returning to their place
 Remove gloves and wash hands
 Record on patient’s chart
Step 5: Key Points (5minutes)
 If the patient is too weak to raise himself, roll the patient to the side away from you, place
bedpan against his buttocks and roll him onto his back with the proper bedpan in position.
 Offer patient water and soap to wash hands, give towel to dry hands
 Remember to observe and document on patient’s chart
 Outline the indications for giving a patient a bedpan and urinal

 What information is necessary before carrying out the procedure for giving and removing
a bedpan and urinal
 What should you observe for before emptying the bedpan /urinal

and Urinals
References
Wilkins.
Profession.
Wilkins.

and Urinals
Session 24: Giving and Removing Sputum Mug
Prerequisite
 None
Learning tasks
 Define common terms used in offering and removing sputum mug
 Outline the purposes of offering and removing sputum mug
 Demonstrate the procedure of offering and removing sputum mug
Resource Needed
SESSION OVERVIEW
Tasks
Common Terms Used in Offering and
Removing Sputum Mug
Brainstorm/ Purposes for Offering and Removing Sputum
3 15 minutes
Discussion Mug
Presentation/
4 30 minutes Offer and Remove Sputum Mug
Demonstration
5 5minutes Presentation Key Points
SESSION CONTENT

NTA Level 4, Semester 1 125 Session 24: Giving and Removing Sputum
Mug
Step 2: Common Terms used in Offering and Removing Sputum Mug
(5 minutes)
Introduction:
 People with productive cough produce a lot of sputum which will necessitate spitting.
Definitions:
 Sputum secretions: are expectorated from the respiratory tract by coughing.
 Sputum mug: is equipment used to receive sputum coughed out by the client.
 Sputum: Is a mixture of saliva and mucus coughed up from the respiratory tract
Step 3: Purposes for Offering and Removing Sputum Mug (15 minutes)

ASK students list the purposes in offering and removal of sputum mug
 To prevent client from coughing and carelessly spitting on the floor

 To provide laboratory specimen from clients with respiratory tract infection
 To prevent cross infection
Step 4: Procedure for Offering and Removing Sputum mug (30 minutes)
Assessment:
 How much can a client provide for self-care?
 Does the client need any assistance during coughing?
 Are there any precautions to be taken while coughing?
Equipment:
 Clean sputum mug
 Sterile container if specimen is required
 Tissue paper
 Gloves
Steps:
 Wash hands, dry and put on gloves
 Take a clean sputum mug and pour in about 10 ml of antiseptic solution. This will prevent
sputum from sticking at the bottom of the mug
 Demonstrate to the client how to press on the handle for opening the lid and release the
handle for closing
 For changing the sputum mug, take a clean one to the client, then remove the used one
 Take it to the sluice room and observe for quantity, consistency, colour or smell before
emptying it

Mug
 Clean the inside of the mug with a mop and warm soapy water
 Rinse with disinfectant and then place on the rack. Separate the lid for drying. Wash
hands before and after removing the gloves
 If a specimen is required, offer the client with a sterile container. Instruct him on the
preference of the early morning specimen.
o He should clean his mouth before coughing.
o He should cough deeply to raise sputum from the bronchi, spit into the container and
close it.
 Fill the laboratory form and send the specimen to the laboratory immediately
 Blood stained sputum should be documented reported to the doctor
 If a specimen is required, offer the client with a sterile container.
 Antiseptic should be poured in a sputum mug to prevent sputum from sticking at the
bottom of the mug
 Instruct client on the preference of the early morning specimen.
o He should clean his mouth before coughing. He should cough deeply to raise sputum
from the bronchi, spit into the container and close it.
 The purposes of offering and removing sputum mug is to prevent client from coughing
and carelessly spitting on the floor and provide laboratory specimen from clients with
respiratory tract infection
 What is the purposes of offering sputum mug to the client

 What are the importance of instructing the patient to cough deeply when sputum
spacemen is required
 Explain the observations are made before emptying the sputum

Mug
References
Wilkins.
Profession.
Wilkins.

Mug
Session 25: Collecting Stool/Urine Specimen
Prerequisites
 None

 Define the terms used in collection of stool/urine specimen
 Explain the purposes for collection stool/urine specimen
 Explain the techniques for specific specimen collection
Resources Needed
SESSION OVERVIEW

1 5minutes
Tasks
Presentation/ Definition of Terms Used in Collection of
2 10 minutes
Buzz Specimen
3 5 minutes Presentation Purposes for Specimen Collection
Presentation/ Perform Procedure for Collection of
4 30 minutes
Demonstration Specimen
SESSION CONTENT


NTA Level 4, Semester 1 129 Session 25: Collecting Stool/Urine
Specimen
Step 2: Definition of Terms Used in Collection of Stool/Urine Specimen
(10 minutes)
TELL students to pair up and define common terms used in collection of specimen for 2
minutes
 Specimen: A part of a thing intended to show kind and quality of the whole.
 Sample: A piece or portion of the whole that will demonstrate the characteristics or
quality of the whole.
 Urinalysis: Analysis of the urine
Step 3: Purposes for Collection of Stool/Urine Specimen (5 minutes)
 Assist in making a diagnosis in conditions of gastro-intestinal/urinary tract infections and

metabolic disorders
 A guide for selecting appropriate medications
 Assessment of client’s progress
 Evaluate the effects of therapy
Step 4: Perform Procedure for Collection of Stool/Urine Specimen

(30 minutes)
Assessment:
 What is the client’s ability to understand instructions for the collection of specimen?
 In what area does the client require assistance in the collection of specimen?
 What is the appropriateness of the procedure?
Equipment
Collecting stool specimen
 Clean stool specimen container
 Sterile culture tube (If indicated)
 2 sterile applicators
 Pair of gloves
 2 disposable spatulas
Routine analysis
 Clean specimen container with a label
 Laboratory requisition form
 Specimen register book
 Pair of clean gloves

Specimen
Collecting clean-catch (mid-stream) specimen
 Sterile specimen container
 Five sterile cotton wool balls
 Antiseptic solution in a sterile galipot
 Container for used swabs
 Sterile gloves
A 24 hour urine specimen collection

 A large container enough for the 24 hour urine collection
 A refrigerator or ice box
 Receiver for voiding (bedpan, urinal or a paint measure)
Collection of stool specimen

 Inform patient about the procedure
 Instruct the patient to use a bedpan when he feels like opening bowels, and ask him not to
put toilet paper in the bedpan
 Ask the patient to inform you as soon as he is ready
 Wash hands, put on gloves and use two disposable spatulas to obtain a specimen and
transfer it into the specimen container
 If the specimen is to be cultured, use the sterile culture tube and the two sterile applicators
to transfer the specimen into the tube
 Secure the cover of the container immediately
 Label the container and take it to the laboratory promptly with the filled requisition form
 Empty the bedpan and clean it thoroughly
 Remove gloves, wash hands and dry
 Record the specimen taken in the patients file and in the specimen register book
Urine specimen collection

Routine analysis:
 Inform the client about the specimen
 Give him a labeled urine specimen bottle. Instruct him to void into the bottle about half
full and close the bottle well
 Record it in the specimen register book
 Fill the laboratory form and put ward stamp, then send to the laboratory
 If it is for routine test in the ward, send it to sluice room and test as required
 Record the results in the client’s chart
Clean-catch specimen
 Inform client about the procedure and assess his level of understanding on the ability to
perform the procedure
 Give careful instructions i.e. client to moisten three cotton wool balls (one at a time) with
the antiseptic solution
 Wash from front to back (in females) left side of meatus, right side and then over the
meatus. In males, clean the meatus three times in circular motion, each swab for one
stroke only the discard into the receiver.
 Ask client to start voiding into toilet or a bedpan/urinal bottle, then place the specimen
container in the middle of the stream to obtain 20mls of urine, then finishes the rest of
voiding into the bedpan, urinal bottle or toilet
 Client replaces the cover of the container without touching the inside
Specimen
 If the client is unable to follow the instructions, or too ill to perform the procedure, assist
as necessary
 Catheterization may be necessary for very ill patients
 Label the container properly and take to laboratory with the requisition form
 Record the collection of specimen in the patient’s chart and the register book
A 24 Hour urine specimen

 Inform the client about the procedure and assess him for the understanding of the
instructions
 Provide client with the 24 hours specimen container and a clean pint measure
 Ask client to empty his bladder immediately prior to the start time? This urine is
discarded.
 Mark the starting and finishing time on the specimen container
 Take the specimen and the laboratory form to laboratory
 Record on patient’s chart
 The entire 24 hour urine specimen should be kept in a refrigerator or an ice box to prevent
bacteria growth
 Catheterization may be necessary for very ill patients
 Instruct the patient to use a bedpan when he feels like opening bowels, and ask him not to
put toilet paper in the bedpan
 Remember to label the container and take it to the laboratory promptly with the filled
requisition form
 why is it necessary to keep the 24 hour urine specimen into a refrigerator or an ice box
 Outline the nurses’ responsibilities when collecting stool/urine specimen
 Why you should use sterile techniques when collecting a specimen for culture

Specimen
References
Wilkins.
Profession.
Wilkins.

Specimen
Session 26: Nasogastric Tube Insertion
Prerequisites
Learning tasks
By the end of this session, students are expected be able to:
 Identify the common terms used nasogastric tube
 Explain the purpose inserting nasogastric tube
 Demonstrate the procedure of nasogastric tube
Resources Needed
SESSION OVERVIEW
Learning Tasks
Nasogastric Tube
Presentation/
3 10 minutes Purposes of Inserting Nasogastric Tube
Buzz
Presentation/
4 30 minutes Procedure of Inserting Nasogastric Tube
Demonstration


134
Step 2: Common Terms Used in Nasogastric Tube (5 minutes)
 Nasogastric intubation is the procedure of inserting tube via nasal passage to provides
access to the stomach for diagnostic and therapeutic purposes.
 A nasogastric tube (NGT) is used for the procedure.
Step 3: Purpose Nasogastric Tube (10 minutes)
TELL students to pair up and mention the purpose of inserting nasogastric tube for 2
minutes
 Administration of medication
 Feeding
 Bowel irrigation
 Diagnostic i.e. identification of the esophagus and stomach on a chest radiograph
 Aspiration of gastric content
 Therapeutic e.g. Relief of symptoms and bowel rest in the setting of small bowel
obstruction
Step 4: Procedure of Inserting Nasogastric Tube (30 minutes)

Equipment:
 Personal protective equipment
 Nasogastric Tube
 Syringe of 10 mls
 Water-soluble lubricant, preferably 2% Xylocaine jelly
 Adhesive tape
 Drainage bag
 Stethoscope
 Cup of water
 Emesis basin
 PH indicator strips
Steps:
 Gather equipment.
 Put on clean gloves
 If possible, sit patient upright for optimal neck/stomach alignment.
 Examine nostrils for deformity/obstructions to determine best side for insertion.
 Measure the tube from bridge of nose to earlobe, then to the point halfway between the
end of the sternum and the navel.

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 Mark measured length with a marker or note the distance.
 Lubricate 2 to 4 inches of tube with lubricant
 Pass tube via nare posteriorly, past the pharynx into the esophagus and then the stomach.
 instruct the patient to swallow (you may offer water) and advance the tube as the patient
swallows. Swallowing of small sips of water may enhance passage of tube into
esophagus.
 If resistance is met, rotate tube slowly with downward advancement toward closes ear.
Do not force.
 Withdraw tube immediately if changes occur in patient’s respiratory status or if tube coils
in mouth, if the patient begins to cough or turns pretty colors.
 Advance tube until mark is reached.
 Check for placement by attaching syringe to free end of the tube, aspirate sample of
gastric contents. Do not inject an air bolus, as the best practice is to test the pH of the
aspirated contents to ensure that the contents are acidic, the pH should be below 6. If
possible obtain an x-ray to verify placement before instilling any feedings/medications or
if you have concerns about the placement of the tube.
 Secure tube with tape or commercially prepared tube holder.
 If for suction, remove syringe from free end of tube; connect to suction; set machine on
type of suction and pressure as prescribed.
 Document the reason for the tube insertion, type & size of tube, the nature and amount of
aspirate, the type of suction and pressure setting if for suction, the nature and amount of
drainage, and the effectiveness of the intervention.
Figure 1: Nasogastric tube in situ
Source: Nursing Crib - Inserting Nasogastric tube

136
 Before insertion of NGT it is important to examine nostrils for deformity/obstructions to

determine best side for insertion and measure the tube from bridge of nose to earlobe,
then to the point halfway between the end of the sternum and the navel.
 This procedure is very uncomfortable for many patients using lubricants may help to
alleviate the discomfort.
 What is the purpose of NGT insertion?

 What are steps of NGT insertion?
References
Nursing Resource. (2012). Nasogastric tube insertion. Retrieved from
http://www.nursing-resource.com
Nursingcrib. (2011). Nursing procedures checklist. Retrieved from
http://www.nursingcrib.com

137
Session 27: Catheterization
Prerequisites

 Identify the common terms used catheterization
 Explain the purpose of catheterization
 Demonstrate the procedure of catheterization
Resources Needed
SESSION OVERVIEW

1 5 minute
Tasks
Catheterization
Presentation/
3 10 minutes Purposes of Catheterization
Buzz
Presentation/
4 30 minutes Procedure of Catheterization
Demonstration
SESSION CONTENT


138
Step 2: Common Terms Used in catheterization (5 minutes)
 Catheterization is the procedure of introducing rubber or plastic tube through the urethra
into the urinary bladder
 Catheter is the plastic or rubber tube used for the procedure.
 Intermittent catheters or straight catheters is the type of catheter which is placed into
the bladder for short time 5 to 10 minutes
 Indwelling/Retention or Foley catheter is the type of catheter placed into the bladder
for extended period of time, have balloons at the distal end that is inflated after insertion
Step 3: Purpose Nasogastric tube (10 minutes)
TELL students to pair up and mention the purpose of catheterization for 2 minutes
 To relieve acute or chronic urinary retention

 For helpless patients
 To empty bladder before, during and after surgery.
 To instill medications into the bladder
 To irrigate the bladder
 To obtain urine specimen for diagnostic purposes.
Step 4: Procedure of Catheterization (30 minutes)
Assessment
 Assess bladder fullness before performing procedure
 Ask patient about any allergies, especially to latex and iodine.
 Ask patient if has been catheterized, if yes, ask why and for how long it was used. The
patient may have urethral strictures that may cause insertion more difficult
Equipment:
 Sterile gloves
 Sterile drapes
 Cleansing solution e.g. Savlon
 Cotton swabs
 Forceps
 Sterile water (usually 10 cc)
 Foley catheter (usually 16-18 French)
 Syringe (usually 10 cc)
 Lubricant (water based jelly or xylocaine jelly)
 Collection bag and tubing

139
Steps:
 Explain procedure to the patient
 Gather equipment.
 Assist patient into supine position with legs spread and feet together
 Open catheterization kit and catheter
 Prepare sterile field, put on sterile gloves
 Check balloon for patency.
 Generously coat the distal portion (2-5 cm) of the catheter with lubricant
 Apply sterile drape
 Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing
solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab
away from sterile field.
 If female, separate labia using non-dominant hand. If male, hold the penis with the non-
dominant hand. Maintain hand position until preparing to inflate balloon.
 Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter
loosely coiled in palm of dominant hand.
 In the male, lift the penis to a position perpendicular to patient's body and apply light
upward traction (with non-dominant hand)
 Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is
noted
Figure 1: catheterization for female and male patients
Source: Department of Emergence Medicine-University of Ottawa
 Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual
balloon size)
 Gently pull catheter until inflation balloon is snug against bladder neck
 Connect catheter to drainage system
 Secure catheter to abdomen or thigh, without tension on tubing
 Place drainage bag below level of bladder
 Evaluate catheter function and amount, color, odor, and quality of urine
 Remove gloves, dispose of equipment appropriately, wash hands

140
 Document size of catheter inserted, amount of water in balloon, patient's response to
procedure, and assessment of urine
 Urinary catheterization is commonly done when a person is unable to urinate using a

toilet, bedpan, urinal, bedside commode, or when accurate urinary output is required
 Catheterization procedure is contraindicated in the presence of urethral trauma. Urethral
injuries may occur in patients with multisystem injuries and pelvic factures, as well as
straddle impacts. So before insertion of catheter it is important to assess for urethral
problems
 What is the purpose of catheterization?

 What are steps of catheterization?
References
Scribd. (2012). Urinary catheter. Retrieved from http://www.scribd.com
University of Ottawa. (2003). Urinary catheter insertion. Retrieved from
http://www.med.uottawa.ca

141
Session 28: Care of a Dying Patient
Total session time 120 minutes
Prerequisites

 Define the term death
 Explain the response to a dying patient
 Outline the signs of a dying patient
 Identify the needs of a dying patient
 Physiology of dying and changes in the body after death
 Explain care of the body After death (Last Offices)
Resources needed
SESSION OVERVIEW

Tasks
Presentation/
2 25 minutes Definition and Response to a Dying Patients
Brainstorm
3 35 minutes Presentation Physical Signs and Needs of Dying Patient
4 5 minutes Presentation Interventions

Presentation/ Physiology of Dying and Changes in the Body
5 20 minutes
Group Discussion After Death
6 20 minutes Presentation Care of the Body After Death (Last Offices)

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SESSION CONTENT
 READ or ASK students to read the learning tasks and clarify
 ASK student if they have any question before proceeding
Step 2: Definition and Response to a Dying Patient (25 minutes)
Activity: Brainstorming (5minutes)

ASK the students to brainstorm on the definition of death for 2minutes
WRITE their responses on a flip chart/ board
Death is:
 "Cessation of heart- lung function, or of whole brain function, or of higher brain function
either irreversible cessation of circulatory and respiratory functions or irreversible
cessation of all functions of the entire brain, including the brain stem"
 Dying and death are painful and personal experiences for those that are dying and their
loved ones caring for them.
 Death affects each person involved in multiple ways, including physically,
psychologically, emotionally, spiritually, and financially.
Responses to dying and death

 Although there are many theories about the emotional transitions encountered by dying
According to “ELISABETH KUBLER-ROSS”, the five emotional stages experienced by
dying individuals are:
o Denial - or “no not me”
o Anger - or “why me?”
o Bargaining - or “Yes, but. . .”
o Depression - or “It’s me!”
o Acceptance - or “It’s part of life. I have to get my life in order.”
 They are widely known in the acronym 'DABDA'.
 These are much like the stages of grief, may overlap, and the duration of any stage may
range from as little as a few hours to as long as months
 The process varies from person to person.
Denial - or “No Not Me”

 On being told that one is dying, there is an initial reaction of shock.
 The patient may appear dazed at first and may then refuse to believe the diagnosis or deny
that anything is wrong.
 Some patients never pass beyond this stage and may go from doctor to doctor until they
find one who supports their position.

143
Anger - or “why me?”
 Patients become frustrated, irritable and angry that they are sick.
 A common response is,” Why me? ”
 They may become angry at God, their fate, a friend, or a family member.
 The anger may be displaced onto the hospital staff or the doctors who are blamed for the
illness.
Bargaining - or “Yes, but. . .”

 The patient may attempt to negotiate with physicians, friends or even God, that in return
for a cure, the person will fulfill one or many promises, such as giving to charity or
reaffirm an earlier faith in God.
Depression - or “It’s me!”

 The patient shows clinical signs of depression- withdrawal, psychomotor retardation,
sleep disturbances, hopelessness and possibly suicidal ideation.
 The depression may be a reaction to the effects of the illness on his or her life or it may be
in anticipation of the approaching death.
Acceptance - or “It’s part of life. I have to get my life in order.”

 The patient realizes that death is inevitable and accepts the universality of the experience.
 Under ideal circumstances, the patient is courageous and is able to talk about his or her
death as he or she faces the unknown.
 People with strong religious beliefs and those who are convinced of a life after death can
find comfort in these beliefs
Step 3: Physical Signs and Needs of Dying Patient (35 minutes)

DIVIDE: students into small manageable group
ASK them to discuss in groups on the signs of a dying patient for 5minutes
AFTER small group discussion, ask students to provide their responses
CLARIFY and Summarize using the contents below
Signs of Approaching Death

 While each person dies in his or her own way, there are more signs with are more or less
common as life comes to an end.
 These are:
o Confusion about time, place, and identity of loved ones;
o Visions of people and places that are not present
o The rate and rhythm of the pulse change. Blood pressure falls
o Breathing is shallow and noisy.
o Mouth breathing is common as the lower jaw drops when body muscles begin to relax
and lose their tone
o A decreased need for food and drink, as well as loss of appetite
o Withdrawal and decreased socialization
o Drowsiness and increased need for sleep and unresponsiveness
o Loss of bowel or bladder control caused by relaxing muscles in the pelvic area

144
o Skin becomes cool to the touch
o Involuntary movements (called myoclonus), changes in heart rate, and loss of reflexes
in the legs and arms also mean that the end of life is near
o “Death rattle” is the term used to describe the noisy respirations which are often due
to accumulation of mucus in the respiratory tract. The nurse should clear the airway.
Often chyne stokes respirations may be present
o Excessive perspiration. The skin is cold, most and pale.
o The nurse should wipe the face with a towel
o The patient may be incontinent of urine and faeces – change the sheets as necessary
o Inability to swallow and speech becomes labored and incoherent
o Vision diminishes, eyelids lower or sometimes the eyes are fixed in one place
o Consciousness may alternate with unconsciousness. The hearing sense is the last to
be lost. So nurses and other caregivers should be careful when discussing matters
about the patient.
o Pain, anguish, fear, air-hunger, restlessness – any or all may be present
o Finally the heart stops beating and respiration ceases.
 It is the duty of the doctor and not the nurse to pronounce the death of the patient. When
the doctor has pronounced the patient’s death proceed with the following:
o Note the date and time of death
o Inform the other ward staff and significant others about the death
o Tidy the dead person and the environment
o Inform the relative and allow them to remain in the room for a few minutes before
escorting them to a quiet place
o Remove the infusion stand, infusion bottle, nasogastric tube bed cradle and other
equipment as indicated.
o Place the body in recumbent position with a pillow on the head. Straighten the limbs
o Close the eyelids. If difficulty is experienced, place a small piece of damp cotton on
each
o Close the mouth. If the mouth sags open apply a bandage to support the jaws
o Cover the body with a sheet and leave for one hour
o Give moral and emotional support to the sorrowful relatives. A variety of reactions
should be expected. Crying is a normal reaction to most Tanzanians. Praying for the
dead person also gives some sort of strength and consolation.
Physical Needs for a Dying Patient

 Death can involve fears that are physical, social, and emotional
 Physical needs of a dying person are similar to the needs of any seriously ill patient.
 Apart from those who die suddenly, there is usually progressive failure of the body’s
vital functions as the person becomes weaker.
Environment for a Dying Patient

 Whenever it is possible the patient should be placed in a side room near the nurse’s
station for convenience of giving nursing care and making frequent observations.
 If such a room is not available move the patient to a convenient part of the ward and
screen he bed to avoid distressing other patients.
 Make the room or environment tidy.
 Inform the relative and friends and if they are in the hospital allow them to be near the
patient. A nurse should be at the bedside always helping the patient and the relative at
this bitter time.

145
Physical Comfort Measures
 Give oral hygiene as necessary.
 Pay particular attention to the care of nose, eyes and skin.
 Change the position of the patient every two hours and make sure that the bed is dry, tidy
and comfortable.
 Give analgesics as prescribed by the doctor.
 Fluid and Nutritional needs
o Terminally ill patients usually have very little interest in food and fluids.
o The doctor will usually order some intravenous infusions to meet the fluid needs.
However the nurse can give sips of water or juice at frequent intervals.
 Elimination
o Some patients may be incontinent of both urine and faeces while others may have
retention of urine.
o Take appropriate measures for these problems as described earlier.
Spiritual Needs of a Dying Patient

 Patients who are terminally ill often become concerned about their spiritual needs.
 They may wish to see a priest, rabbi, sheikh or religious counselor.
 If a patient wishes so, every effort should be made to get the clergyman for the patient.
 Different religious faiths vary in the way of meeting the dying patient’s needs.
 Each has meaning and spiritual strength for its followers.
 The nurse must respect the religious beliefs of the patient even if she has a different
religious belief.
Attitude of the Nurse

 No matter how often the nurse is in the presence of a dying person, it is never a pleasant
experience.
 Because the family and relatives of the patient are distressed and often helpless it is
necessary for the nurse to remain calm and steady so that she may provide for the family
and relatives strength and assurance.
 The nurse must be sensitive to the needs and feelings of people and be able to meet those
needs effectively.
 With experience the nurse will be able to handle this situation more effectively.
Step 4: Interventions (5minutes)
The main goals of interventions are:

 To keep the patient comfortable and free of pain
 To make the patient's final days as good as possible for both patient and family, with little
suffering as possible
 To help the patient to die peacefully
 To provide comfort to the family
 It is important for nurses who care for the dying to be aware of their own feelings about
death and their patients
 It is important for nurses to recognize those feelings
 Nurses need to comfort and support each other in their care of the dying patient

146
 Relieve patient fears through:
o Talk as needed
o Avoiding superficial answers, i.e. “It’s God’s will
o Providing religious support as appropriate
o Staying with the patient as needed
o Working with families to strengthen and support
Step 5: Physiology of Dying and Changes in the Body After Death (20
minutes)
Physiology of Dying
The basic body changes result in the death of all vital body systems
 Pulmonary:
o Unable to oxygenate the body
o Assess for poor oxygenation-skin pale, cyanotic, mottled and cool
o In dark skinned - assess mucous membranes, palms of hands and soles of feet
 Cardiovascular
o Large load on heart when lungs fail
o Heart not getting needed oxygen
o Pumping heart not strong enough to circulate blood
o Blood backs up causing failure
o Leads to pulmonary and liver congestion
 Blood circulation
o Decreased, as heart loses ability to pump
o May have a “drenching sweat” as death approaches
o Pulse becomes weak and irregular
o If pulse relatively strong, death is hours away
o If pulse is weak and irregular, death is imminent
o Combination of these events leads to cell death, and death of the organism (human)
o As pulmonary and cardiovascular systems fail, other body systems begins to fail
 Failing metabolism
o Metabolic rate decreases, almost stopping
o Feaces might be retained or incontinence might be present
 Failing Urinary System
o Urinary output decreases
o Blood pressure too low for kidney filtration
o Further load on cardiovascular system due to increase circulating volume
 Failing Nervous System
o Decrease oxygen to the brain, means decreasing brain function
o Sensation and power lost in legs, first, then arms
o May remain conscious, semi-conscious, or comatose
 Specific Sensory Decline
o Dying person turns toward light - sees only what is near
o Can only hear what is distinctly spoken
o Touch is diminished - response to pressure last to leave
o Dying person might turn toward or speak to someone not visible to anyone else
o Eyes may remain open even if unconscious
o Person might rally just before dying

147
 Further Neurologic Decline at Death
o Pupils might react sluggishly or not at all to light
o Pain might be significant
o Assess for pain if person unable to talk: restlessness, tight muscles, facial
expressions, frowns
o Provide pain medication as needed
 Further Neurologic Decline at Death
o Pupils might react sluggishly or not at all to light
o Pain might be significant
o Assess for pain if person unable to talk: restlessness, tight muscles, facial
expressions, frowns
o Provide pain medication as needed
 Never Lose Sight.
o Death is the end, as we know it, for that person
o We can only support, listen therapeutically, and
o Make the person as physically comfortable as possible
o We can also use our knowledge and expertise to strengthen, support, and prepare the
family
Changes in the Body after Death

Rigor Mortis
 Body becomes stiff within 4 hours after death as a result of decreased ATP production.
ATP keeps muscles soft and supple.
Algor Mortis
 Temperature decreases by a few degrees each hour.
 The skin loses its elasticity and will tear easily.
Livor Mortis
 Dependant parts of body become discolored.
 The patient will likely be lying on their back, their backside being the 'dependant' body
part.
 The discoloration is a result of blood pooling, as the hemoglobin breaks down.
Step 6: Care of the Body After Death (Last Offices) (20 minutes)
Guidelines
 Give respect and dignity throughout the handling of the body from the moment of death
until the body is collected for burial
 Limbs have to be straightened, eyes and mouth closed before rigor mortis sets in.
 Rigor mortis refers to stiffening of skeletal muscles which occurs few hours after death
and may persist for 4-6 days
 Proper identification of the body by attaching on the body clear identification tag
 Patient’s valuables should be listed and handed to proper authority for safe keeping until
the relatives come to collect them
 Respect the patient’s religious belief and allow any religious ritual that may be requested
 Preparation of the body
 Use personal protective equipment as necessary

148
Requirements
 Equipment for bed bath
 Cotton wool
 Dressings, bandages and scissors
 Forceps
 Kidney dish
 Identification label or tags
 Two special linen for last office
 Safety pins
Recommended Technique
 Two nurses if possible should work together in a respectful manner
 Proceed as for bed bath
 Remove ornaments and jewelers.
 Ask relatives if the wedding ring should be left on.
 Close the mouth and eyes. Using a forceps pack the rectum and vagina with cotton wool
to avoid leakage.
 If the nose and other orifices are leaking, pack them with cotton wool.
 Be careful not to disfigure the face
 Replace dirty dressings with clean ones as may be necessary
 Wrap the body with special linen for last office and ensure that it is in good position
 Fill information required on identification tags.
 Tie one tag around the ankle
 Wrap a second sheet over the body. Fold appropriately to cover the head and feet.
 Fix with bandages or safety pins
o Fasten securely a second identification label on the second sheet.
o The two labels (tags) should indicate:
 Full names
 Age, sex, ward, hospital number
 Date, and time of death
o Call the mortuary personnel and assist in transferring the dead body to the mortuary.
o The body will be kept in cold room until relatives come to collect.
o If cold facilities are not available in the mortuary the relative should be notified at
once so that they may come to collect the body before it decomposes
o Record the patient’s belongings according to hospital policy and send them for safe
keeping.
o When a relative comes to collect them, ensure that he signs before collecting.
o Clean and care for equipment accordingly (as per IPC guide)
o Include the patient’s death in your report and the nursing officer in charge of the shift
should send a report to the Matron’s office.
Death Certificate
 The laws of the United Republic of Tanzania require that a death certificate be prepared
for each patient who has died.
 The certificate should be signed by the doctor who attended the patient.
 The original certificate is given to the relative when taking their dead body.
 A copy of the certificate remains in the hospital for record purposes.

149
 Cessation of heart- lung function, or of whole brain function, or of higher brain function.
 Either irreversible cessation of circulatory and respiratory functions or irreversible
cessation of all functions of the entire brain, including the brain stem"
 Dying and death are painful and personal experiences for those that are dying and their
loved ones caring for them.
 While each person dies in his or her own way, there are more signs with are more or less
common as life comes on an end
 What are the physical signs of approaching death?

 What are the needs of dying patient?
References
Wilkins.
Profession.
Wilkins.

150
Session 29: The Concept of Nursing Process
Total Session Time: 120
Prerequisite
 None
Learning tasks
 Define the term nursing process
 Explain the characteristics of the nursing process
 Explain the steps of the nursing process
Resources needed
SESSION OVERVIEW

Tasks
2 5 minutes Presentation Definition of the Nursing Process
3 40 minutes Buzzing/Discussion Characteristics of the Nursing Process
4 60 minutes Presentation Steps of the Nursing Process

SESSION CONTENT


151
Step 2: Definition of Nursing Process (5 minutes)
 Process: Series of steps or events that lead to achievement of specific results

 Nursing Process: The nursing process is a series of planned steps and actions directed at
meeting the needs and solving the problems of people. It is a scientific method adapted to
the often unpredictable conditions of human life and applied to human beings who have
unmet needs.
Step 3: Characteristics of the Nursing Process (40 minutes)
 A systematic approach
o The nursing process provides a systematic approach for nurses to assist clients.
o The purposes of the nursing process include maintenance of health, prevention of
illness, promotion of recovery, restoration of wellness and maximal function and
support in peaceful death
 Interrelated and fluid steps

o The steps of the process are interrelated.
o One step builds on the next and is dependent of the preceding step.
o Example: a nurse may remove a dressing (implementation) and assess the condition of
the wound, and teach the client about the signs and symptoms of wound infection.
The nurse will evaluate the client’s reaction to the teaching, and decide whether
another teaching is required
 A person-centered process
o The person is at the center of the process.
o The nurse involves that person in each step of the nursing process from assessment
through evaluation
 Emphasizes Feedback
o Feedback is emphasized; for example the result of the five steps (evaluation of the
interventions) are fed back into the system, leading to a revision of the care plan as
needed
 Facilitates creativity
o The nursing process allows maximal creativity on the part of the nurse as well as the
maximal use of education and skills
 Foundation of nursing practice

o The nursing process forms the foundation for nursing practice.
o It defines nursing practice in state practice acts and is used to organize nursing
textbooks and state nursing board exams

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Step 4: Steps of the Nursing Process (60 minutes)
IMPLEMENTATION, EVALUATION
review planned Refer to established
interventions, schedule outcomes, and
and coordinate them
evaluate them
PLANNING ASSESSMENT
Establish priorities Collect data, review
records, interview,
Develop outcomes
nursing history, physical
Set time frames assessment
DIAGNOSIS
Interpret data, validate
inferences, identify
related factors,
document
The Five Steps of the Nursing Process

Assessment
 The process of assessment is a systematic collection of subjective and objective
information about an individual, family and community.
 The aim is to obtain adequate and necessary data that will help in making a clinical
nursing judgment.
 The first step in caring for a patient is to gather and document complete and accurate
nursing history.
 During the process of assessment, the nurse has to demonstrate skills in history taking,
performing head to toe examination and physical examination through inspection,
palpation and auscultation

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What the nurse does in the assessment process
 Determines what information to be collected
 Identifies sources of information to be used in collecting the data
Sources of information:
 Primary source- the patient
 Secondary sources- family members, friends, significant others
Subjective data
 Subjective is a term related to issues that are influenced by thoughts and emotions but not
actual facts of either the patient or of the nurse.
 Emotions are feelings of any kind, or an idea or belief not based completely on reason
 The nurse needs to be aware that subjective data reflects patient’s symptoms, views,
feelings, perceptions, preferences, values, ideas, expectations and information that only
the client can state and validate.
 The data can be obtained through interview or when a nurse is taking patient’s history
during assessment.
Objective Data
 An objective data is a term related to issues that are influenced by what exist or real, what
can be seen, touched, smelled, tasted, or heard and not by emotions.
 The nurse needs to be aware that objective data can be directly observed or measured
such as vital signs, appearance, laboratory tests, and nonverbal expressions like gesture,
posture, movements and facial expression.
 The data can be obtained through health records, laboratory tests and investigation results,
patient’s file and physical examination results.
Methods that can be used for data collection include

 Observation
 Interviewing
 Review of previous records
 Examining
Tools that can be used for data collection are

 Checklist
 Specific care charts
 Physical examination instruments such as- stethoscope, aural scope, laryngoscope, and
vital sign equipment
 Interview guide
 Laboratory testing facilities
Stating Nursing Diagnosis

 After recording the information which was obtained in the process of assessment the next
step is to formulate the nursing diagnosis.
 Nursing diagnosis is a comprehensive statement of actual or potential health concerns that
describes the outcome of the assessment based on the subjective and objective data which
guide a nurse to make decision through independent nursing interventions.

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 The nurse makes a nursing diagnosis when identifies the particular problems which are
preventing the patient from doing personal safety, eating and drinking, communicating,
personal cleansing and dressing, eliminating, maintaining normal body temperature,
resting and sleeping, mobilizing, learning, working and playing, attending to spiritual
needs and expressing emotions.
 It is the label which prompts the nurse to decide on nursing interventions.
Actions in making a Nursing Diagnosis

 Reviews the data for completeness and organization
 Interprets the data/ making sense out of the data by comparing with the standards or
baseline values
 Identifies the patient’s problems which can either be actual or potential
An actual problem
 This is the existing problem or the problem that is being manifested at present, for
example- altered skin integrity (damaged skin) or altered urinary elimination (problems in
elimination)
A potential problem
 This is an expected to happen as an outcome or a complication of the existing health
problem or condition.
 For example- potential to impaired skin integrity (being prone to skin damage), or
potential for impaired urinary elimination (prone to urinary elimination problems
Planning
 This is the action of determining how to assist the patient in resolving the health needs,
problems and concerns.
 It requires deliberate decision making and problem solving. It provides documenting the
necessary and appropriate interventions and approaches to alleviate or reduce the
identified patient’s health concerns.
 The nurse is expected to use professional and intellectual judgment in choosing which
aspect of the process to share with the patient
Activities in the planning process:

 Setting priorities: Judging on what should be done first as priorities.
o These include existing life threatening concerns or those are likely to occur within a
short time
o Availability of human, material and time resources to address the life threatening
concerns
o References that assist in strengthening the reasons for the decision taken
 Setting goals:
o A goal represent an eager, earnest, serious and constant desire and determination to
achieve something with attention
o In the process of planning, goals are related to indicators of performance.
o They describe what is going to happen to the patient and to what extent that are
mutually acceptable to both the patient and the nurse
o The goals may be short term whose results appear within a short time or long term
whose results appear after a relatively long period of time

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 Setting objectives of care
o An objective is a written intent that states a change of behavior which lasts for a
relatively long period.
o The intent has three characteristics which the nurse must watch out for performance,
conditions and criteria
o A performance objective is what the patient should be able to do as a result of a
nursing intervention
o A condition objective is a state in which the patient will be doing the performance
objective such as the patient’s experience.
o Criteria objectives are the standards by which performance of a patient is evaluated. It
is related to any variable which can be used to test or measure.
o Criterion objectives include speed and accuracy, quality of the performance of the
patient.
o Developing list of nursing interventions and strategies.
o A strategy is related to a method or approach that guides what to be done and how is
to be done by the patient and the nurse such as problem solving, caring, coping, self-
involvement, teaching and learning, comforting, tenderness, and direct assistance.
Implementation
 Implementation is related to actual carrying out or executing the plan by the nurse and the
patient. As the nurse is implementing she continues to assess, validate concerns and
modify the plan and priorities.
 The implementation process comprises of the following three components:
Preparation Phase
 During this phase the nurse prepares herself and the patient to be ready and willing to
carry out the prescribed tasks and strategies of the plan in order to ascertain whether the
plan is still valid and relevant, priorities have not changed, it safe to go ahead, legal and
ethical aspects have been taken into consideration.
 The nurse prepares the patent physically, mentally, socially and spiritually to enhance
patient’s participation in the nursing process.
 Also prepares the equipment and supplies appropriate to the care which will be given and
environment to ensure comfort and privacy
Implementation Phase
 During this phase the nurse is actually doing the activities.
 She performs and assists the patient to perform skillfully, efficiently and competently.
 The nurse put emphasis and focus on the patients more than on the specific procedure or
the strategy that is reaching rather than how she is completing a procedure
Documentation
 On completion of performance objective, the nurse must put in writing the actions which
were implemented by the nurse and the patient; it includes actions which were not carried
out and reasons with focus on the progress of the patient.
 The type f recording system will depend on the health care facility in which the nurse is
working.

156
Evaluation
 Evaluation is related to a planned systematic activity of comparing the current health
status of a patient with the goals and objectives which were put in place. The purposes of
evaluation include:
o To determine the patient’s progress
o To judge the effectiveness of the nursing interventions and strategies
 The activities that the nurse has to be involved in during the process of evaluation are:
o Collection of data concerning the adequacy of existing resources, policy guidelines
and staffing levels
o Reviewing charts, nursing competency rating scale, quality patient care scale and
nursing audit
o Assessing the patient’s responses, reactions and progress to health status
 During a nursing assessment the nurse systematically collects, verifies, analyses and
communicates data about client
 Nursing diagnosis is a statement that describes the client’s actual or potential responses to
a health problem that the nurse is licensed and competent to treat.
 Planning is a category of nursing behaviors in which clients centered goals and expected
outcomes are established, and nursing interventions are selected to achieve the goals and
outcomes of care
 Implementation describes a category of nursing behaviors in which the actions are
necessary for achieving the goals and expected outcomes of nursing care initiated and
completed
 During evaluation the nurse decides if the previous steps of the nursing process were
effective by examining the client’s response and comparing them with the behaviors
stated in the expected outcomes
 What is nursing process?

 Outline the five steps in the nursing process
 What are the methods that can be used in collecting data

157
References
Wilkins.
Profession.
Wilkins.

158
Session 30: The Nursing Process
Prerequisite
 None
Learning Tasks
 Formulate a nursing diagnosis
 Prioritize patients problems and needs, develop plan of care
 Implement a plan of care
Resources needed
SESSION OVERVIEW

Tasks
2 20 minutes Buzzing/Discussion Formulate a Nursing Diagnosis

Prioritize Patients Problems and Needs,
Develop Plan of Care
Presentation
4 40 minutes Implement a Plan of Care
SESSION CONTENT

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Step 2: Formulate a Nursing Diagnosis (20 minutes)
Introduction
 A nursing diagnosis is a clinical judgment about individual, family or community
responses to actual or potential health problems /life processes.
 Nursing diagnoses provide the basis for selection of nursing interventions to achieve
outcomes for which the nurse is accountable
 Both medical and nursing diagnoses are necessary and valid.
 To develop a person’s total diagnostic picture, nurses and physician must work together
as well as independently. Also they must communicate their findings to one another
The Diagnostic Process

 The data collected during the assessment must be sorted, organized, analyzed and
interpreted for a nursing diagnosis to be made.
Analysis and Interpretation

 Interpretation is based on cues and inferences.
 Cues are subjective or objective pieces of information obtained through assessment.
 Diagnostic cues are clinical evidence that describes a cluster of behaviors or signs and
symptoms that represent a diagnostic label
 The potential for making an accurate nursing diagnosis increases when you use a cluster
of cues rather than a single cue.
 Example: You saw a person grimacing; this facial expression (clue) could have a variety
of meanings including anger, disagreement, or pain.
 When you see the person grimacing and rubbing his part of his body and moaning, this
cluster of cues leads to conclusion that the person is experiencing pain
Making and Validating Inferences

 The process of assigning meaning to a cue or cluster of cues is Inference.
 Theory, experience, intuition and validation are used to make an inference.
 You can ask the person ‘Are you in pain?’ to validate or verify the inference.
Comparing cues and clusters of cues with defining characteristics

 Defining characteristics are clinical cues that cluster as manifestations of a nursing
diagnosis. Defining characteristics are categorized as major or minor.
 Major defining characteristics are present 80-100% of the time when a person is
experiencing a particular nursing diagnosis
 Minor defining characteristics may be present 50-79% of the time but increases your
confidence that you are making the correct diagnosis

160
Identifying the related factors
 Related factors are conditions or circumstances that can cause or contribute to the
development of the diagnosis.
 Related factors can be environmental, physiologic, psychosocial or spiritual factors that
contribute to the development of the problem
Documenting the nursing Diagnosis

 The list of NANDA approved nursing diagnosis should be referred for the development
of diagnostic statements
Guidelines for writing an actual nursing diagnosis

 Write the diagnosis in terms of person’s response Rather than Nursing Needs
 Use ‘Related to’ Rather than ‘Due to’ or ‘caused by’ to connect the two parts of the
statement
 Write the diagnosis in legally advisable terms
 Write the diagnosis without value judgment
 Avoid revising the parts of the statement
 Avoid using single cues in the first part of the statement
 The two parts of the statement should not mean the same thing
 Express the related factor in terms that can be changed
 Do not include medical diagnosis in the nursing diagnosis
 State the diagnosis clearly and concisely
Examples:
 Infective airway clearance related to increased secretions as evidenced by ineffective and
unproductive cough or abnormal breath sounds
 Impaired Communication related to language barrier as evidenced by inability to speak
English
Step 3: Prioritize Patients Problems and Needs, Develop Plan of Care

(40minutes)
 The first step in planning nursing care is to decide which nursing diagnosis requires
immediate attention and which ones are less threatening.
 Nursing diagnoses are ranked as having high, medium or low priority
High-priority nursing diagnoses

 They are life threatening and require immediate actions e.g. High risk for aspiration, high
risk for violence
Medium-priority nursing diagnoses

 They do not directly threaten a person’s life, although they may result in unhealthy
physical or emotional consequences e.g. impaired physical mobility may result in several
problems
Low-priority nursing diagnoses

 These are problems that a person can handle with minimal assistance

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A wellness nursing diagnosis
 A wellness diagnoses focus on the nurse’s role in promoting health and prevention of
illness.
 A wellness diagnosis is defined as a clinical judgment about an individual, family or
community in transition from a specific level of wellness to a higher level of wellness.
Example: Potential for enhances parenting.
Developing Specific Outcomes

 Outcomes are concrete descriptions of the type of behavior the person will display if the
plan of care has been successful. The outcome must be;
o Acceptable to the person
o Realistic
o Consistent with the plans of the entire health team
Setting Time Frames

 It is essential to determine a realistic deadline or time frame for accomplishing the
outcomes. E.g. resume normal bowel pattern within 3 days.
Identifying Interventions
 Nursing interventions are nursing actions that focus on assisting people to cope
successfully with the problems and to achieve the outcome
The Nursing Care Plan

 This is a written plan that communicates the nursing diagnosis (actual, high risk and /or
wellness), the outcome and nursing interventions.
 Nurses develop a nursing care plan to accomplish the following purposes:
o Provides a detailed guide for nursing care
o Individualizes nursing care
o Provides a source of information and a line of communication for nursing team
members
o Foster continuity of care
o Coordinates the efforts of the nursing team members
o Provide for individual and family participation in the nursing care plan
o Outlines the program for nursing education of individuals and significant others
o Encourage adequate discharge planning
o Provides a source of information for quality improvement and research
Step 4: Implement a Plan of Care (45 minutes)

 The implementation phase of the nursing process draws heavily on the cognitive,
interpersonal and technical skills of the nurse.
 Decision making, observation and communication are significant skills.
 These skills are utilized by the client, nurse, nursing team members and health team
members.
Cognitive intellectual skills

These skills include:
 Problem solving
 Decision making
 Critical thinking
 Innovation

162
Interpersonal skills
 Verbal communication
 Nonverbal communication
 Teaching
 Counseling
 Conveying caring
Technical psychomotor skills

 Preparation, adjustment of equipment
 Pouring, or drawing up medication
 Making beds
 Giving injections
 Changing dressings and so on
This phase of the nursing process focuses heavily on the process of determining whether the
client has achieved the outcomes as stated in the plan of care.
The evaluation has six steps which are listed below:

 Step 1: Refer to the client’s planned outcomes. These stated outcomes become the criteria
for evaluating whether or not the outcome has been achieved
 Step 2: Evaluate the client’s condition and compare actual outcome to the expected
outcome
 Step 3: Summarizes the result of evaluation
 Step 4: Identify reasons for client’s failure if indicated to achieve the expected outcome.
They include:
o Error in formulation of the outcomes, or incomplete assessment
o Inappropriate interventions
o Uncooperative attitudes on the part of the person
 Step 5: Take corrective action to modify the plan of care as necessary
 Step 6: Document the evaluation of the client’s achievement of the outcome and the
modification, if any of the plan of care

163
Step 5: Key Points
Summary of the Nursing Process
Assessment Nursing diagnosis Planning Implementation Evaluation

 Collect data.  Interpret data.  Establish priorities.  Review the planned interventions.  Refer to established outcomes.
 Review of clinical Identify cluster of  Develop outcomes.  Schedule and coordinate the  Evaluate the individual’s
records. cues.  Identify person’s total health care. condition and compare actual
 Review nursing  Make inferences. interventions.  Collaborate with other team outcomes with expected
history.  Validate  Document plan of members. outcomes.
 Physical assessment. inferences. care  Supervise implementation of the  Summarize the results of the
 Psychosocial  Compare clusters nursing care plan by delegating evaluation.
assessment. of cues with appropriate responsibilities.  Identify reasons for the
 Consultations. definition and  Counsel the person and person’s failure, if indicated,
 Review of literature defining significant others. Involve the to achieve expected outcomes
characteristics. person in the health care. stated in the plan of care.
Identify related  Teach the client and family as  Take concrete actions to
factors. needed. modify the plan of care as
 Document the  Refer individuals who require necessary.
nursing diagnosis continuing care.  Document the evaluation of
 Document the care provided the person’s achievement of
outcomes and modifications if
any in the plan of car

164
 What are the skills used during implementation of the nursing care
 Outline 6 steps in the evaluation process
References
Wilkins.
Profession.
Wilkins.

165
Session 31: Physical Assessment
Prerequisites
Learning tasks
 Define common terms used in physical assessment
 Outline the purposes for physical assessment
 Describe the technique for physical assessment
Resources Needed
SESSION OVERVIEW

Presentation Presentation of Session Title and
1 5 minutes
Learning Tasks
Presentation/ Definition of Common Terms Used in
2 10minutes
Brainstorm Physical Assessment
3 15 minutes Presentation Purposes for Physical Assessment
Presentation/
4 80 minutes Physical Assessment Technique
Demonstration
SESSION CONTENT
Step 1: Presentation of Session Title and Learning tasks (5 minutes)


166
Step 2: Definition of Common Terms Used in Physical Examination
(10 minutes)
ASK the students to brainstorm on definition of common terms in physical examination
Inspection
 This is careful, close and detailed visual examination of a body part, in order to identify
potential and actual problems that can be prevented or treated
Palpation
 This is feeling of body tissue or parts with use of hands
Percussion
 This is tapping or striking your fingers against the client’s body. The resulting sounds
indicate the place and intensity of body tissue or organs. The aim is to detect abnormality
underlying the body structures
Auscultation
 It refers to listening sound from the body, usually with the aid of a stethoscope or using
an ultrasound blood flow detector (Doppler)
Step 3: Purposes for Physical Assessment (15 minutes)
 To gather baseline data about the client’s health

 To detect physiological changes within the specific body system involved
 To confirm nursing/medical diagnosis
 To provide quality nursing care in relation to the knowledge acquired during physical
assessment
 To determine client’s eligibility for health insurance or employment
Step 4: Procedure for Physical Assessment (80 minutes)
 Determine the general condition of the of the client

 Identify what precautions need to be taken in relation to the client’s age, group or mental
status
 Determine the place where the examination is going to be conducted
 Assess for how much of the information the client is willing to offer
Preparation of the patient

 Discuss with the patient about the procedure

 Ensure privacy and safety
 Make sure the room is clean, quiet with minimal interruption

167
Preparation of the nurse
 Review skills for physical examination procedure
 Obtain informed consent from the patient
 Review literature regarding physical examination procedure
Equipment
Vital sign tray containing:
 Thermometer
 Sphygmomanometer
 Stethoscope
 Ophthalmoscope
 Otoscope
 Turning fork
 Tape measure
 Torch
 A watch with second hand or pulsometer
 Gloves
General Observations (Head to toe assessment)

Appearance
 General health appearance and for significant physical features
 Height in relation to the body stature
 Jaundice, pallor or cyanosis
 Posture
 Grooming and dressing habits
 Be alert with body or breath odors
Orientation
 Assess level of consciousness and awareness of person, place and time
 Assess mood- relaxed, anxious, friendly or hostile
 Test his memory by asking him some questions
Vital signs
 Take and record temperature, pulse respirations and blood pressure
The general skin appearance

 Check for colour- pallor, cyanosis or jaundice. Assess the skin for texture
 Check pressure points, lesions, rashes or skin excoriations
The head
 Any tenderness over the skull by palpation
 Texture and cleanliness of the hair
 Shape and size of the head
The eyes
 Examine the eyes for infection (redness)
 Check for any protrusion or sunken eye boll
 Check if the eyelids open and close normally
 Check for anemia

168
 Check the sclera for bleeding points indicating sub-conjunctiva hemorrhage
 Palpate the eye globe with eyelids closed –hardness means increased intraocular pressure
indicating a sign of glaucoma
 Check if the pupils are equal in size and react to light
The Nose
 Observe for flaring of the nostrils – indicating difficulty in breathing and a need for
oxygen
 Watch for any nasal discharge or redness of the mucous membranes- indicating signs of
infection
 Note any septal displacement which may indicate trauma
 Check for patency of the nostrils by asking the patient to inhale while you press one
nostril closed
 Palpate the areas over the frontal and maxillary sinuses; tenderness indicates sinusitis
The Ears
 Observe for normal ear placement – abnormal placement may indicate a congenital
abnormality
 Check the ear canal for discharge which may indicate sign of infection
 Examine the canal and the tympanic membranes – redness indicate infection
The Mouth and Throat

 Assess condition of the teeth- any cavities or missing teeth indicate periodontal disease
 Inspect the oral cavity for abnormalities like thrush
 Inspect the tongue for paleness, ulcers, or dryness
 Inspect the throat for swelling ulcers or redness
 Ask the patient if he experience pain or difficulty in swallowing
The Neck
 Palpate the thyroid glands for swelling
 Palpate the area in front of the ear and on the sides of the neck for swelling and
tenderness of the lymph nodes which may indicate ear or throat infection
 Palpate the area under the chin – swollen lymph nodes indicate infection or tooth abscess
The Chest
 Inspect right and left surfaces of the chest for symmetry, appearance and movement
 Examine the breasts for size shape, swelling
 Note any abnormal discharge from the nipples
 With the client lying on her back, assist her to raise her arm and place under her head in
order to spread out breast tissue. Palpate breast on that side starting from the nipple
outward up to the axilla. Note any lymph nodes or lumps.
 Any abnormal findings noted should be reported for further investigations
 Teach the client on how to perform self breast examination and that she will continue
doing regularly
The lungs
 Observe rate and type of respiration – relaxed or labored
 Perform percussion over the lung lobes to detect lung ailments

169
 Auscultation will reveal any abnormal air entry into the lungs e.g. wheezing occurs in
asthmatic condition, or air obstruction, cracking sounds for clients with pneumonia – a
definite outward chest movement a struggling heart
 Auscultation over the heart will reveal abnormal heart sounds
 Percussion of the heart is done from the axilla inwards. A heartfelt further to the left than
normal indicates enlargement
The heart
 Inspect movements of the heart over the chest wall
The Abdomen
 Inspect the surface for symmetry, color, and presence of any scars
 Palpate the abdomen systematically for tenderness, enlargement of the liver, spleen or
abdominal mass
 Observe the patient’s reaction for pain or discomforts as you palpate the abdomen
The Extremities
 Observe arms and legs for symmetry, movement and deformities
 Move the joints to full range and note any difficulties
 Palpate all surfaces to detect any abnormal swelling or varicose veins in the lower
extremities
 Ask the client to walk away from you and towards you and assess gait movement
 Assess peripheral pulse and note any abnormalities
The back
 Skin (texture, color)
 Spine
The genitalia:-Female
 Ask the client to remove her underpants
 Ask her to lie on her back, flex knees to expose her genitalia
 Inspect the external genitalia for any lesions, redness of the vulva, genital mutilation and
vaginal discharge
 Ask patient if she experience itching or burning sensation on micturation
The genitalia: - Male

 Assist client to a standing or lying position
 Inspect the penis for lesions, appearance, swelling and placement of the urethral opening
 Check for scrotal swelling, skin condition
Step 5: Key Points
 The examination room must be well ventilated with adequate lighting to enable you see
clearly the patient’s condition
 Ensure adequate privacy during physical assessment
 Abnormalities detected should be recorded and reported for further management

170
Step 6: Evaluation
 What action will you take if you detected problem after assessment?
 How would you emotionally prepare the client before doing physical examination?
 What are the reasons for communicating the assessment findings to the client?
References
Wilkins.
Profession.
Wilkins.

171
Session 32: Assessment of an Unconscious Patient
Total session time: 60 minutes
Prerequisite
 Anatomy and Physiology
Learning tasks
 Define common terms used in assessment of an unconscious patient
 Outline the purposes for assessing an unconscious patient
 Describe the technique for assessing an unconscious patient
Resources needed
SESSION OVERVIEW

Learning Tasks
Common Terms Used in Unconscious
Patient
Presentation , Group Purposes for Assessing an Unconscious
3 13 minutes
Discussion Patient
Presentation&
4 35 minutes Assessment for an Unconscious Patient
Demonstration

NTA Level 4, Semester 1 172 Session 32: Assessment of an Unconscious
Patient
Step 2: Common Terms Used (5 minutes)
Introduction
 Assessment of conscious levels is important for an unconscious patient and especially so
when brain damage is present.
 The Glasgow Coma Scale is used to grade changes in verbal response, motor response
and eye opening. Together with pupil size reaction, strength or weakness of extremities
and vital signs will greatly assist in rating patient’s condition.
 The highest score is 15 and lowest is 3.
 A client scoring less than 8 should be cared for in the intensive care unit.
Definitions
 Consciousness: Is defined as a state of being aware of external stimuli.
 Unconsciousness: Is defined as a state of being partly or completely unaware of external
stimuli.
 Glasgow Coma Scale: Is a technique for assessing patient’s level of consciousness, it
tests three major areas; eye response, verbal response and motor response.
o Is commonly used to assess patients with head injury.
Step 3: Purposes for Assessing an Unconscious Patient (13 minutes)
ASK students to discuss in groups on the purposes for assessing an unconscious patient
 To detect the extent of brain damage in a patient with head injury

 To assist in planning care of an unconscious patient
 To detect progress after surgery or head injury
Step 4: Assessment of Unconscious Patient Using Glasgow Coma Scale
Assessment:
 Time when the client sustained the injury
 Whether there was loss of consciousness after the injury. Was he able to communicate
and identify the environment soon after the injury
 Any change in the level of consciousness from the time of injury to the time of
assessment
Equipments:
 Torch
 Patellar hammer
 Pin or needle

Patient
 Cotton wool
 Turning fork
 Glasgow coma chart
Assess the client for the following responses and score him basing on the standards below:
Items Assessment Responses Scores points

1 For eye opening Spontaneous 4
To voice 3
To pain 2
None 1
2 For verbal responses Orientation 5
Confused 4
Inappropriate words 3
Incomprehensible words 2
None 1
3 For motor responses Obeys commands 6
Localized pain 5
Withdraw from pain 4
Flexion pain 3
Extension pain 2
None 1
Summary of total Glasgow Coma scale points
Score Rate Evaluation

14-15 5 patient is alert and completely oriented
9-13 4 Semi-conscious
6-8 3 Patient in coma state
4-5 2 or less Patient is totally unresponsive
 Assessment of conscious levels is important for an unconscious patient and especially so

when brain damage is present.
 Good assessment can be obtained by using the Glasgow Coma Scale
 What are the purposes for using the Glasgow Coma Scale?
 What are the indications for assessing the client using the Glasgow Coma scale?
 What are the techniques used to evaluate unconscious patient using Glasgow Coma scale?

Patient
References
Wilkins.
Profession.
Wilkins.

Patient
Session 33: Positions Used in Nursing Patients
Pre requisite:

 List common positions used in hospital settings
 Outline reasons for positioning patients
 Describe the technique used in positioning patients
Resources Needed
SESSION OVERVIEW

Tasks
2 3minutes Presentation Common Positions Used in Hospital Settings
3 5 minutes Buzzing/Discussion Reasons for Positioning Patients

Presentation/
4 45 minutes Technique Used in Positioning of Patients
Demonstration
SESSION CONTENT

NTA Level 4, Semester 1 176 Session 33: Positions Used in Nursing
Patients
Step 2: Common Positions Used in Hospitals (3 minutes)
 Appropriate positioning of patients in bed is important and is part of care given depending
the condition of the patient; also is used to facilitate various investigation procedures and
examinations of patients.
o Supine Dorsal/ Recumbent position
o Lateral/Side –lying position
o Prone position
o IV Sim’s Position
o Knee-chest position
o Orthopedic position
o Trendelenburg position
o Orthopedic position
o Lithotomy position
o Fowler’s position (semi recumbent)
Step 3: Reasons for Positioning Patients (10 minutes)

ASK students list the reasons for positioning patients for 2 minutes
Reasons
 For specific examinations
 For various nursing procedure
 For care and treatment e.g. First Aid measures for a patient in shock, asthmatic attack,
cardiac attack, fracture
 For comfort and pain relief
 For prevention of pressure sores
 For operation procedures
Step 4: Techniques Used in Positioning of Patients (40 minutes)

Preparation of patients
 Inform patient about the procedure
 Assess patient condition and determine the position, equipment and number of staff
required

 Assess the environment and provide adequate space
 Ensure privacy of the patient
Equipment
 Towels
 Pillows

Patients
 Sandbags
 Footboards
 Backrest
 Fracture boards
 Air rings
 Stirrups
 Over bed table
Positioning of patients
Supine Dorsal/ Recumbent position
Procedure
 Position patient on his/her back with the spine in straight alignment
 Place a pillow under the head to prevent neck extension
 Arms may be at the patient’s side with the hands prorated (inner side of the palm facing
down)
 If patient is paralyzed, hand rolls should be in place to maintain the hand
 If both legs are paralyzed, place a roll on either side at the hip or the ankle.
 The foot should be supported so that the toes point upwards in an anatomical position
 Use footboards, sandbags or a strong cardboard/ carton to maintain the feet at right angles
to the legs
Source: Brookside press.org
Lateral/Side –lying position

Procedure
 Place the patient on his/her side (left or right) with head supported on a low pillow
 Under tuck a pillow along the patients back to support the back and maintain position
 Bring the underlying arm forward and flex it out on the pillow in front of the body, put
hand rolls in place if needed
 The top leg should be flexed and brought slightly forward to provide balance
 A pillow placed lengthwise under the top leg keeps the legs separated and supports the
top leg
 Take care to support the feet to prevent planter flexion and foot drop
 Change position two hourly to prevent pressure sores.

Patients
Figure 1: Lateral position
Source: Taysirassistance.com
Prone position
Procedure
 Place patient on the abdomen and turn the head to one side
 Make sure the spine is straight
 Use small pillow or a folded bath towel for comfort under his head
 Place the arms flat at patient‘s side or flexed at the elbow with the hands near the
patient’s head
 Place hand rolls if needed.
 For tall patients, the feet should extend beyond the end of the mattress so that they
point down in the space between the mattress and foot board.
 With short patients, place a roll under the ankles to keep the feet in proper alignment
Figure 2: Prone position

Patients
Sim’s Position
Procedure
 Place the patient as per lateral position
o Using only one pillow under the head
 Flex the knee of bottom leg sharply and the right knee sharply on the abdomen
Figure 3: Sims position
Source: Stanford School of Medicine
Knee-chest position
Procedure
 Kneels the patient on the bed or table
 Tell the patient to lean forward with hips in the air and chest arms on the bed or table
 A pillow can be placed under the patient‘s head
 Drape patient to allow visibility of rectal area and cover the rest of the body
o NB: Knees should be flexed
Trendelenburg position
Procedure
 Place a patient on his/her back as (dorsal position)
 Low the patient head at 45 degree angle below the horizontal level
Figure 4: Trendelenburg position
Source: lpnkorea.com

Patients
Orthopedic position
Procedure
Place patient in sitting up position in the bed or at the edge of the bed with chest or over bed
table
 Place small flat pillow over the table
 Elevate the table to a comfortable height
 Ask/Assist the patient to lean forward and rest head and arms on the table for support
Lithotomy position
Procedure
 Place patient in a supine/dorsal position
 Flex both knees simultaneous Separate the legs widely maintaining the flex position
 If the patient is on the examination table, the feet can be placed on the stirrups
 Drape the patient to provide visibility of the perineal area
 If necessary adjust the foot of the bed to provide access to the perineal area
 Cover the legs and the body
Figure 5: Lithotomy position
Source: Hopkinsarthritis.org
Fowler’s position (semi recumbent)

Procedure
 Place patient in a supine position with the head of bed elevated to an angle more than
45degrees (high fowlers position)
 Center the patient on his back so that when the head is elevated, the break /center the bed
will be in the hips
 Raise the head of the bed to the desired height
 Allow the patient’s head to rest against the mattress or support it with a small pillow
Patients
 Support the patient’s hands on a pillow so that they are in line with the forearms and
slightly elevated in relation to elbows
 Support forearms so that they are elevated sufficiently to prevent pull on patients
Shoulders
 Use air ring on the buttocks to relieve pressure
 Slightly elevate knees for brief periods only
 Support the feet at right angles at ankle joint to the lower legs using pillows, a
 toot board or a foot block
Figure 6: Fowlers position
Figure 7: Semi Fowlers’ position

Patients
 Place patient in an appropriate position to maintain normal body alignment and

functioning
 Ensure privacy and gently handling patient during positioning
 Use relevant requirement (devices) when changing patient position
 Two hourly changing of patient position is necessary to maintain patient’s comfort,
stimulate blood circulation and prevention of pressure sores
 Ensure privacy is maintained
 What are reasons for positioning of the patient?

 What are the common positions in caring patients?
References
Wilkins.
Profession.
Wilkins.

Patients
Session 34: Maintaining Body Mechanics
Pre requisite:
By the end of this session students are expected to be able to:

 Define common terms used in body mechanics
 Outline the purposes of application of body mechanics
 Describe the principles of body mechanics
 Demonstrate the procedure on lifting a helpless patient
Resources needed
SESSION OVERVIEW

Presentation of Session Content and Learning
Tasks
2 5 minutes Presentation Common Terms Used
Buzzing/
3 15 minutes Purpose of Application of Body Mechanics
Discussion
4 10 minutes Presentation Principles of Body Mechanics
Presentation/
5 75 minutes Lift a Helpless Patient
Demonstration
SESSION CONTENT

184
Step 2: Common Terms Used in Application of Body Mechanics
(5 minutes)
Introduction
 Many patients admitted in hospital are quite sick and may not be able to change position
or move out of the bed on their own.
 In order to accomplish this goal, nurses have to learn how to assist the patients to new
positions without causing problems to the patients or to themselves.
Definitions
 Body mechanics: Is the term used describe the manner in which you move your body
during everyday activities
 Alignment: Is defined as the relationship of the individual body segments to each other
 Body alignment: Is ideal balanced posture in which positioning is centered and relaxed
for all the joint of the body
STEP 3: Purpose of Maintaining Body Mechanics (15 minutes)
Purposes
 To assist client move from one place to another for different reasons
 To promote comfort
 To promote good body alignment to prevent complications in cases of prolonged bed rest
 To prevent further damage e.g. in fractures
Step 4: Principles Used in Body Mechanics (10 minutes)
Good body mechanics can be maintained by adhering to the following basic principles.
 Keep feet apart (at least 12 inches) when lifting objects
 Get as close to the object as possible, bend at the hips and knees and lift with your leg
muscles, while maintaining a straight back
 Wear appropriate shoes i.e. flat shoes
 If the health care provider sits for a long period of time, place a roll behind the back to
maintain straight back.
 Moving in a rhythmic way and avoiding jerky and uncoordinated movements.

185
Step 5: Procedure of Lifting a Helpless Patient (75 minutes)
Assessment:
 Is it appropriate time for the procedure
 What support will you need for the procedure
 What is the client’s general condition
Equipment:
 clean sheet and blanket
 stretcher
 pillow and pillow cases
 clean readymade bed
 gloves (If necessary)
Moving a patient from stretcher to bed

 Assess patient’s status in order to plan correctly
 Ask for three nurses to help in lifting the patient
 Inform the patient , wash hands, dry and put on glove if necessary
 Organize the three nurses to stand on the side of the stretcher facing the bed, as close to
the stretcher as possible facing the client
 The three nurses put their arms as far as possible under the patient. One nurse support
client’s head and shoulders, one support the back and buttocks, and the third nurse
support the thighs and ankles.
 With legs slightly apart, they lift the patient onto bed. Make sure the patient is well
covered with the top sheet. Position patient comfortably by arranging pillows, and tidying
the rest of the bed
Moving client from bed to chair

 Two nurses will be needed for the procedure
 Inform the patient about the procedure and obtain his cooperation
 Wash hands, dry them and put on gloves if necessary
 Place chair/wheelchair close to the side of the bed
 Help patient to sit at the edge of the bed for a few seconds to prevent orthostatic
hypotension
 Two nurses join hands under patient’s thighs, and other hands support the back. Patient
put his hands around nurses’ shoulders
 Both nurses stoop and lift the patient simultaneously, they rotate slowly so that the chair
is behind the patient
 Put the patient gently on the chair, position him to be comfortable in the chair.
 Put slippers on his feet and cover him well with sheet to prevent chilling
Turning patient in bed

 Inform patient of the planned action and obtain his co operation
 Remove patient’s top linen leaving him covered with a top sheet
 Adjust bed accessories that need protection during movement
 Place your foot in front of the other, one arm under the patient’s shoulder and the other
arm under his hips. Rock to your rear leg to move patient towards you.
 If the patient is to turn to the left side, move him on the right side of the bed

186
 If the patient is to turn to the right side, cross his right leg over the left
 If only one nurse working alone, go round the bed and stand on the side of bed towards
which the patient will be turned.
 Place one hand under the shoulder and the other under his hips, roll him towards you
 Replace bed linen and make patient comfortable
 Remove screen and clear up the equipment used
 Wash hands after procedure
Turning patient by using Log Rolling for client who must not flex his back
 Two nurses are necessary for this procedure
 Inform patient about the planned action
 Screen the bed to provide privacy
 Wash hands, dry and put on gloves if necessary
 Re adjust necessary equipment e.g. drip stand, urinary catheter and so on
 Loose draw sheet under patient and roll it on both sides to about 10 inches from the
patient
 Use the draw sheet to move the patient to the side of the bed. If the client is to turn to the
left side, position left arm next to body and the right arm across the chest, and vice versa
if turning to the right side
 In unison both nurses use the draw sheet to turn patient to the side lying position
 Straighten bottom sheet to remove bed wrinkles
 Remake the bed and leave the patient comfortable
 Clear up equipment after procedure and wash hands after procedure.
 Patients who have been lying in bed for a long time get low blood pressure when brought
to a sitting up (orthostatic hypotension).
 Allow the patient to sit on the bed for few seconds before lifting him to the chair
 Never attempt to log-roll a patient with spinal cord injury or surgery by yourself to avoid
flexion on his back
 While turning a patient with spinal cord injury the nurses should turn in unison to keep
patient’s back straight.
 What can nurses do in order to avoid straining their backs while lifting and turning
patients in bed?
 How unconscious patient should be moved from stretcher to bed?

187
References
Wilkins.
Profession.
Wilkins.

188
Session 35: Legislation Issues in Nursing and Midwifery
Total Session time: 60 minutes
Prerequisites
None

By the end of this session students will be able to:
 Define the common terms related to legislation in nursing and midwifery practice
 Explain the importance of legislation issues in nursing and midwifery practice
 Describe legislation issues in Nursing practice
Resources Needed
SESSION OVERVIEW

Presentation of Session Content and
Learning Tasks
Definition of the Common Terms Related
Presentation/
2 10 minutes to Legislation in Nursing and Midwifery
Brainstorming
Practice
Importance of Legislation Issues in
Nursing and Midwifery Practice
4 10minutes Presentation Legal Issues in Nursing
Steps Used in Registration, Enrollment and
Licensure in the Nursing Profession
5 5 minutes Presentation Key Point
SESSION CONTENT

NTA Level 4, Semester 1 189 Session 35: Legislation Issues in Nursing
and Midwifery
Step 2: Definitions of the Related Terms (10minutes)

ASK students to define the common terms related to legislation in nursing and midwifery
practice
Introduction
 Ethics is and always has been an essential component of nursing practice.
 Ethical principles such as respect right to life, respect for persons, consent and
confidentiality are basic to nurse-patient relationship.
 However, the application of these principles in specific situations is often problematic,
since nurses, patients, their family members and other healthcare personnel may disagree
about what is the right way to act in a situation.
 Setting of Laws and regulations help to govern the practice of nursing according to the
established standards aiming to safe guard public health
Definitions
 Ethics: Is a system of moral principles or standards governing conduct. It is concerned
with judgments about what is right or wrong conduct in relation to moral conflicts
 Legislation: Means laws that in each state are used as instruments that define the scope
of practice.
 Negligence: Is defined as a conduct which fall below the set standards which are
established by law or regulation (failure to conform with applicable standards of care)
 Malpractice: Means doing wrong or bad thing resulting to harm or tort.
 Legal liability:
 Means that the perpetrator must bear the punishment for his/her act or compensate the
aggrieved party.
 It must be proved that the conduct caused harmful consequence, which is sometimes
problematic.
 The conduct must be Wrongful or Unlawful and therefore unreasonable in the eyes
of society, lastly the individual must be responsible.
Step 3: Importance of Legislation in Nursing and Midwifery Care

(5 minutes)
 Legislation is important for nurses as it keep directives on professional conduct and

practice.
 Having legislation provide public health protection, promotion and preservation of the
public health, safety and welfare through regulation and control of nursing and midwifery
education and practice

and Midwifery
Step 4: Legal Issue in Nursing (10 minutes)
 Nursing profession is exists for the purpose of meeting the needs of society.
 ICN describe the code of nurses conduct must focus to society and people needs.
 Nurses are authorized legally to provide acceptable care to those individuals believed to
be skilled and knowledgeable in all aspects and work with other members in health care
facility for the optimal health of the public.
 Professional status is being maintained through adherence of the ethical code of conduct
where the stated elementary principles guide nurses’ practices.
 Ignorance of codes of nursing ethics by individual nurse is regarded as negligence hence a
professional nurse practice below the standards of nursing practice.
 Legal issues in nursing hence prescribed when individual fails to practice with the ethical
code of conduct by not adherence on professional competencies, not responsible and
accountable, unfaithful, mistrust, breach confidentiality, selfish, abuse individual respect
and dignity leading to misconduct and all sort of malpractice, a certified copy of
employment/contract letter.
Step 5: Steps Used in Registration, Enrollment and Licensure in the

Nursing Profession (15 minutes)
 Nurses and midwives who have such qualification recognized by the council and have
passed examination conducted by the Council shall be registered in appropriate part and
section
 Every application for registration in respect of each part of the register shall be
accompanied by:-
o A certified copies of his qualifications;
o A certificate or letter for completion of internship (if applicable)
o Four recent colored passport size photographs;
o A letter of passing examination;
o Registration fee as prescribed in under first schedule of these Regulations.
o No person shall practice as a nurse or midwives in Tanzania unless he is enrolled
upon fulfillment of the conditions prescribed under section 15(1) of the Act
o Every registered nurse or midwife shall submit before 31st December of the third year,
file information to the Council for the retention of his name in the register;
o Any nurse or midwife who wishes to be temporarily registered shall be required to fill
in and submit the application form approved by the council
 Every application for registration made under sub-regulation 11 (1) of The Nursing and
Midwifery (Registration, Enrollment and Licensing) Regulations, 2010 shall be
accompanied by a nonrefundable fee as prescribed in regulations
 If the applicants is a foreigner shall in addition to submit the following requirements set
out under that regulation be accompanied by the following documents:
o Certified copies of his nursing or midwifery education equivalent to diploma and
degree offered in Tanzania;
o Full transcript of academic record certified by a head of the institution or academic
body where he graduated as nurse or midwife;
o Evidence that he is registered as nurse or midwife in the country in which the
institution or examining body that awarded such qualification is situated;
o Evidence that he is a physically fit and proper person and in good standing as a nurse
or midwife with relevant registration authority from the country where is coming;

and Midwifery
o There shall be a need to translate any documents by an approved authority and the
cost of translation shall be incurred by an applicant;
o Two recent colored passport size photographs and
o a copy of current Curriculum Vitae
o A certified copy of employment/contract letter;
o They shall be an allowance of six to eight weeks to process the registration.
o As a part of registration process, the council shall contact all countries in which a
current license is held, more over the Council reserves the right to check with all
countries in which the applicant has ever been licensed
 Registration and enrollment of nurses in the register roll is important as it provide nurses
with assurance and essence to practice within the code of ethical practice.
 For individual registration, enrollment and licensing must have attended and completed
stipulated training
 Adherence of registration rules in nursing practice provide assurance for individual
practice
 What is the different between registration and licensing?

 Explain the importance of registration
 Outline the steps in the process of registration, enrollment and licensing
References
Brent, N. J. (1997). Nurses and the law: A guide to principles and applications. USA:
W. B. Saunders.
TNMC. (2010). Nursing and midwifery act. Dar es Salaam: The United Republic of Tanzania
Act Supplement.
TNMC. (2010). Nursing and midwifery (registration, enrollment and licensing) regulations.
Dar es Salaam: The United Republic of Tanzania Act Supplement.
Unknown. (n.d.). Nursing legislation. Retrieved from http://www.righthealth.com

and Midwifery
Session 36: Nursing Legislation Process in Provision of
Care
Pre-requisites
 None
Learning Tasks
 Describe the legislation process
 Describe legal regulations and omissions in nursing and midwifery practice
 Explain the types of law in nursing and midwifery
Resources Needed
SESSION OVERVIEW

Tasks
Presentation/
2 35 minutes Legislation Process
Brainstorm
The Common Legal Regulations and
Omission in Nursing and Midwifery Practice
4 30 minutes Presentation The Types of Law in Nursing and Midwifery
SESSION CONTENT


NTA Level 4, Semester 1 193 Session 36: Nursing Legislation Process in
Provision of Care
Step 2: Legislation Process (35 minutes)
Initiation of the process
 Identification of a need for changes in the bill, this can be identified by public interest,
organization or individual who using the law (need assessment) and transform the idea
into a specific legislative
 Discussion of the idea of concerning on the proposed need or changes
 Draft proposal into acceptable legislative form and language with the aid of an attorney
 Find a person (attorney) who will deal with the proposal and ensure its success through
the next step – Ministry of Health and Social Well fair is responsible to guide the process
Introduction of the proposed bill

 The drafted proposed bill introduced to the senate and is given number for first reading
 The concerned committee in the senate assigned to deal with the proposed legislation. In
this stage public attendants and participation is welcomed.
Assignment to committee
 Thorough discussion and examination of the proposed legislation and the committee may
vote to pass the bill in its original or may decide to make changes to the bill
(amendments) then vote for further process which is to.
o Recommend the bill to be passed or passed as amended and sent direct to the floor
o Recommend that the bill be passed or passed as amended and be sent to another
committee
o Recommend that the bill be passed or passed as amended and placed on the Consent
Calendar
o Sent the bill to the floor or another committee without recommendation for passage
o Defeat the bill or keep it in the committee indefinitely
o Reporting back to the legislative body about the decision made so that to work on it
Presentation in the floor for second reading

 Reading of the bill to the committee before its final presented to the full senate. During
this stage every member is given opportunity to actively debate the merits of the bill and
propose amendments to it.
 The legislation body work on the proposed recommendation, preliminary approve the bill
and submit it to the senators desk for discussion and voting for approval
 In case pressing legislation the process waves to allow for more immediate attention if
not , the bill is placed in the calendar to be then read for the third time
 Voting for passing the bill. If the cabinet committee member passes the bill is then
 Submission to the cabinet house and presented by the committee
 Cabinets takes the final vote on the bill then proceeded to a conference committee with
the suggested amendments
Action by President or Governor

 The conference committee once reaches consensus, the proposed bill is sent to the cabinet
to be approved by the Governor or the President for signature.
The bill becomes a Law

 From the date of approval and signature indicate effectively time to use the Law, if the
bill is not indicate the specified date of approval is not enacted as a bill

Provision of Care
 Once passed into Law, the bill is given a public designation and number e.g. The nursing
and midwifery Act. No. 1 of 2010 passed on 26th March 2010.
 Registered and printed in the United Republic gazette by Government Printer.
Implementation of the new Law

 Once passed, the new Law must be carried out by the agency/ legislation body
 Prepare rule and regulations that provide guidance to the greatest number of individual
use of the Law under the guidance of the attorney
 Approval of rules by organization authorize officer ( MOHSW- Minister)
 Disseminate the new Law and regulation to various stakeholder and the end users
 Ensure appropriate implementation of the Laws and regulations
Step 3: Common Legal Regulations and Omission in Nursing and

Midwifery Care (40 minutes)
 In Tanzania the legislation guideline which is governing nursing and midwifery practice
is Tanzania Nursing and Midwifery Act, 2010 together with its regulations.
 There are four prepared regulations as follows;

o The Nursing and Midwifery (training) regulations,2010
 This regulation provides guide to any individual who wishes to establish nursing
and midwifery school. This includes the registration, licensing and
implementation of curriculum
o The Nursing and Midwifery (practice) regulation, 2010
 This regulation provides guidance on the process to be adhered by a nurse
practitioners and those wishes to establish private nursing and midwifery practice
o The Nursing and Midwifery (fitness to practice) regulation,2010
 Regulation provides information on the process to be carried to deal with any
reported complaints to the Council on nursing misconduct
o The Nursing and Midwifery (registration, enrollment and licensing ) regulations,2010
 This regulation provide information on the categories for registration parties,
conditions, requirement and procedure to be followed for registration as well as
well as the removal from the register roll to Tanzanian and oversees Nurses and
Midwives.
Step 4: Types of Law in Nursing and Midwifery (30 minutes)
 The Nursing and Midwifery Act, No. 1 of 2010 prepared to make provision for the
protection, promotion and preservation of the public health safety and welfare through
regulation and control of nursing and midwifery education and practice
 It divided into parts
o Part I- Preliminary provisions. Gives definition of the related words used in the Act.
o Part II- Describe the establishment of the Council, including the composition of the
Council members, Functions of the Council, Committee and delegation of powers and
function of the Council
o Part III- Management and Staff of the Council, including appointment, the duties
allocation of the Registrar, Deputy Registrar and Supervisory authority.
o Part IV- Registration , Enrollment and Licensing procedure, includes eligibility for
registration, types of registration and indication for removal from the register or roll
Provision of Care
o Part V- Registration and licensing procedure for private practice.
o Part VI- Disciplinary provisions, for any complaints or inquiries and appeal.
o Part VII- Financial provisions
o Part VIII- Offences and penalties, for illegal practice of any part of the Act.
o Part IX- Miscellaneous provisions.
o Other Laws that governing nurses
 There are others public laws that governs the society behavior in respect to relationships
with others and the government
o Nurses being among the society members are obliged to the established rules and
penalties given to people who violate them
 The Law can function as public or private rules. The following are types of Laws
 Statutory (Legislative) Law: The type of Law that provides guidance in professional
practice and changes (including prescriptive authorities) and proposed health care
reforms. It concern with criminal law which prevent assault and harm to the society and
provide punishment for crimes. Violation of criminal Law one punished by
imprisonment or penalties
 Civil Law: The one that protect the right of individual within society and encourage fair
and equitable treatment and care
 Constitutional Law: The law state on the right of the citizen (society) of the United
Nation of Tanzania for freedom of speech, religion and equal protection.
 Nursing actions must take into accounts on these basic rights which are consistent with
the ethical principles of autonomy, confidentiality, respect for person and veracity.
 Administrative Law: This involves the operation and regulation of the government both
local and central agencies activities related to education, public health and social welfare
programs. It consist legal power to all administrative agencies by legislative bodies to
carry out their powers.
 TNMC is one the board functions under the Nursing and Midwifery Act derived from this
Law.

 For good standing of the legislation process, the regulatory authority should keep abreast
on the changes that occur in the professional and the country.
 Involvement of all stakeholders in all process of legislation process review is of important
in order to come up with effective document
 Regulations /rules formulation and dissemination of the Law is the final stage of
legislation process as it provide guidance to the greatest number of individuals on how to
comply with the prepared Law

 What is the difference legislation and ethics?
 What are the importance of legislations
 What are the steps followed in legislation process
 ASK students if they have any comments or need clarification on any points

Provision of Care
References
W. B. Saunders.
Act Supplement.
TNMC. (2010). The nursing and midwifery (fitness to practice) regulations. Dar es Salaam:
The United Republic of Tanzania Act Supplement.

Provision of Care
Session 37: The Nurse’s Code of Professional Conduct
Prerequisites
 None
Learning Tasks
 Define common terms related to nurse’s code of conduct
 Identify the purpose of nurses’ code of conduct
 Explain the nurse’s code of conduct guiding principles
Resources needed
SESSION OVERVIEW

Presentation of the Nurses Code of
Professional Conduct
Presentation/ Common Terms Related to Nurse’s Code
2 20 minutes
Group Discussion of Conduct
3 10 minutes Presentation Purpose of Nurses Code of Conduct
Nurse’s Code of Conduct Guiding
Principles
SESSION CONTENT

NTA Level 4, Semester 1 198 Session 37: The Nurse’s Code of
Step 2: Definition of the Common Terms Related to Nurse’s Code of
Conduct (20 minutes)
ASK students to discuss in groups on the common terms related to nurse’s Code of
Conduct for 4 minutes
Introduction
 The code of professional conduct for nurses and midwives sets out conventional
principles and expectations that will be binding to all nurses in the country.
 It provide guidance for decision making concerning the ethical matters, serves as a means
for evaluation and reflection regarding ethical nursing practice, and also provides a basis
for peer review initiatives to address changes according to the need of the society, values
,and conditions that challenge ability of nurses to practice ethically.
Definitions:
 Code: Is an authoritative system of written rules, which are similar to Law and are
binding and formulated to regulate behavior
 Ethics: Is concerned with judgments about what is right or wrong conduct in relation to
moral conflicts.
 Principle: Is an established role of action to be followed in implementing set of activities.
 Ethical Principle: Ethical Principle is the process in decision making and problem
solving undertaken by a person with a sound moral principle.
 Code of ethics: Is the rule that governing and regulates the conduct of members
 Code of conduct: Provides a framework that defines the core value and standards which
professional must follow.
 Code of ethics for professional nurses: Is a rule that provides nurses with direction for
ethical decision making and practice in everyday situations as they are influenced by
current trends and conditions, It applies to all nurses in all practical settings,
 Pledge: Is solemn promise or a vow
 Dilemma: Is a situation requires a choice between what seems to be equally desirable or
undesirable alternatives
 An ethical dilemma: Is situation that will often involve a conflict that brings questions
on which to obey as one would result affecting others.
 The ethical problems has characteristics includes that, the problem cannot be solved just
using only empirical data, the problem must be so perplexing that deciding what facts and
data need to be used in making decision become difficult and the results of the problem
when solved must affect more than immediate situation
 Ethical distress: Is when the situation has no readymade answers that can be offered,
thoughtful consideration is required to facility the process and quality of decision making.
Sometimes feelings of guilt, concern or hatred may occur
 Value: Is something that is deeply cared about
Step 3: Purpose of Nurses Code of Conduct (10 minutes)
 To guide the professional nurses in providing compassionate care and love to the
patient/clients so as to attain acceptable standards such as respect for human dignity and
the uniqueness of the client.
 To guide the professionals in the ever-changing world of education, practice, research,
leadership and management. For example, the nurse should participate in activities that
contribute to the ongoing development of the profession’s body of knowledge
 Enables nurses and midwives to make decision on patient care approaches
Step 4: Code of Conduct Guiding Principles (15 minutes)

As a nurse licensed to practice by TNMC, you are personally accountable for your practice.
The following are the principles to follow when caring for patients:
 Respect for humankind and the patient/client as an individual: The nurse provides
services with respect for human life and dignity
 Obtain consent before providing care: Obtain patient’s valid consent for care receiving,
respect his/her autonomy
 Maintain professional competence: Nurses must strive at all times to achieve and
maintain high professional standards in providing quality care through evidence based
practice to safeguard the safety of the client/patient.
 Take responsibility and be accountable for your acts: Every nurse should be
responsible and accountable for his nursing judgment and actions.
 Be trustworthy and exercise fairness: Every nurse has the duty to behave in the way
that uphold good reputation of the profession, has to be fair in distributing resources and
at all times to tell the truth and be loyal in whatever form
 Collaborate with others and act as part of the team: The nurse collaborates with other
members of the health team and other sectors in promoting health needs of the clients and
the public at large
 Protect confidential information: Information about patient and clients must be treated
as confidential and be used for the purposes for which it was given. As it is impractical to
obtain consent every time you need to share information with others, you should ensure
that patients and clients understand that some information may be made available to other
members of the team involved in the delivery of care.
 Always the nurse safeguards the client’s right to privacy: Respect the privacy of a
patient/client in such a way that during the procedure, privacy is provided and maintained
throughout.
 Nurses have fundamental responsibilities to promote health, to prevent illness, to restore

health and to alleviate suffering.
 Code of professional ethics provides a set of specific descriptive values that designed to
regulate conduct of profession in more specific situations.
 It provides description of a nurse and society, practice, people, coworkers and the
profession. Individual nurse should be aware on the values needed to each discipline and
employ during care provision

 What are the purposes of nurses’ code of conduct?

 Outline three code of conduct guiding principles for nurses
 Explain how you will ensure the implementation of the nurses code of conduct
References
W. B. Saunders.
Act Supplement.

Session 38: Professional Responsibilities in Relation to
Level of Licensure
Pre-requisites
 None
Learning Tasks
 Explain the meaning of accountability and consent
 Explain the importance of accountability
 Describe on proper accountability
Resources Needed
SESSION OVERVIEW

Tasks
Presentation/
2 10 minutes Meaning of Accountability and Consent
Brainstorming
3 10 minutes Presentation Importance of Accountability
Presentation/
4 25 minutes Proper Accountability
Discussion
SESSION CONTENT

NTA Level 4, Semester 1 202 Session 38: Professional Responsibilities in
Relation to Level of Licensure
Step 2: Meaning of Accountability and Consent (10 minutes)

ASK to state the meaning of accountability and consent
Introduction
 Accountability is one of the legal aspects of professional nursing practice, it provide
professional nurses with integral rules of practice hence to become responsible for any
action taken and omissions
 It also provides individual self audit, peer review and establishment of open working
relationships with colleagues wherein honest constructive criticism and standards is
welcomed for the greatest goal of quality of services.
Definition
 Accountability: means that individuals agree to be morally responsible for the
consequences of their actions
OR
 Means avoiding making assumptions when you are part of a team effort, you may at times
feel as though you are the only one who is following through to fulfill a responsibility; or
you may feel that another team member should be aware of your feelings.
OR
 Is the fulfillment of a formal obligation to disclose to referent others the purposes,
principles, procedures, relationships, results, income and expenditures for which one has
authority.
o Disclosure is systematic, periodic, and carried out in consistent form.
o Disclosure occurs so that decisions and evaluations can be made and action carried
out as a formal obligation.
Consent
 Is defined a granting of permission by the patient for the an act to be carried by another
person
Types of consents
 Informed consent: This is the type of consent where by the consent is obtained only after
the patient/client received full disclose of all pertinent information regarding the
procedure and only if the patient/client understand the potential benefits and risks
associated with doing so
 Implied consent: This is the type of consent whereby practitioner( physician) states in the
progress notes of the medical records that the patient/client is unable to sign but that the
treatment is immediate needed and is for patient/client best interest. Validation of this
type of consent must be done by another practitioner.
 Expressed: This is the type of consent whereby the nurse witnesses a patient/client
signing the consent form. She must be assured that the patient/client has received the
information prior the signature.

Step 3: Importance of Accountability (10 minutes)
 Nurse's been the first priority profession need to become accountable in the
implementation of nursing activity as it maintain trust in relationships, precisely what
you want to do – accountable and trustworthy and honest relationships.
 Increase commitment and promising to take specific tasks i.e. make the individual to
obtain more information, respond only to a reasoned informed decision, taking into
account the time commitment, the specific tasks required, the kind of support available.
 Accountability works best when there is regular communication, which includes updates
about a project and your individual responsibilities.
 Helps to perform negotiation with regard to roles and responsibilities.
 Don't assume that you must commit yourself to a request as it is present, need for
resource to accomplish and what support you will need from them.
 Help in problem-solving, which allows nurses to keep involved in the project with
lessened responsibilities.
 Allows flexibility in case of change, so your responsibilities may be subject to change as
well.
Step 4: Proper Accountability (25 minutes)

There are six key strategies for transforming changes in the department
 Strategize for service
o Where does service fit in the strategic initiatives of your department? Defining your
unique service culture is akin to having your own secret pickle recipe.
o What are the formal and informal leaders in your department saying (and more
importantly doing) about service excellence.
o Does everyone in your department know how their job impacts patient satisfaction
survey results
 Organize for service
o This is the technological proven strategies for creating a culture of service excellence.
o Other elements of organizing for service include policies & procedures, job
descriptions, staff scheduling, service standards and scripting.
o A test to make sure your policies and procedures are written with the patient health
progress in mind.
o Creating and agreeing upon universal service standards provides the unique spices
and flavoring for your department.
o What behaviors can staff perform routinely to demonstrate to your patients the culture
of healthcare service in your department?
 Select & train for service
o Using behavior based interviewing questions and validated pre-hire assessment allows
nurse managers to select staff who already embrace the service standards of your
department.
o Orientation and on-the-job training provide important foundations for staff.
o Making sure there is congruence once the staff arrives in their department is trickier,
but achievable with strong management support. On-going training keeps all
practitioners updated allows for service excellence over time

 Deliver excellent services
o This step is where the rubber meets the road or the pickle meets the customer with a
well defined service behavior which are competency based provide the foundation for
service delivery.
o The expectation is that these behaviors are demonstrated daily and with ease.
o Positive first impressions play a major role in setting the stage for service excellence.
o During this stage when problems do occur, service recovery procedures need to be set
up to allow staff to solve service problems at the front line.
o The delivery of excellent service is evidenced by positive attitudes, friendly smiles
and high quality work output.
 Manage for service
o As steps one through four is being implemented, the nurse manager has a major
responsibility for insuring the success of the process.
o Communicating strategic alignment (or the pickle recipe) is the first step toward
culture change. Do staff members in your department really understand the service
vision? In addition, regular contact with patients using surveys, focus groups and
rounding provide real time data for managers helps improve the quality of services.
However, On-going coaching lets staff know what is important on a regular basis.
 Sustain service momentum
o Last, but not least, measuring patient satisfaction provides important data for making
better decisions. Standardizing operations to decrease variation on the job is another
key element.
o Staff members who are providing excellent patient care want their managers to
manage low performers to get them to "shape up or ship out".
o Employee satisfaction is a key indicator of patient ‘satisfaction so this is a good place
to start. Keep your eyes open for fresh ideas from other types of service related
businesses and see what might work in your organization.
 Accountability is of equal importance to commitment and success in the organization

 Is one of the legal aspects of professional nursing practice
 For appropriate accountability one has to develop strategies which help to meet
organization goal and improve services as it provide changes in department through
progressive changing activities
 What is the importance of accountability?

 What are the differences between accountability and responsibility?
 Explain how you will practice proper accountability

References
W. B. Saunders.
TNMC. (2009). Module on ethics in nursing. Dar es Salaam, Tanzania.
TNMC. (2009). Nursing ethics: A manual for nurses. Dar es Salaam, Tanzania.

Session 39: Moral Conduct in the Nursing Profession
Prerequisites
 None

 Define the term moral conduct
 Explain type of moral conduct
 Explain the moral issues in a health care setting
Resources Needed
SESSION OVERVIEW
Step Time Activities/Method Content

Tasks
Presentation/
2 15 minutes Moral Conduct
Brainstorming
Presentation/
3 30 minutes Moral Issues in a Health Care Setting
Discussion
SESSION CONTENT

READ and ASK students to read the learning tasks and clarify.

NTA Level 4, Semester 1 207 Session 39: Moral Conduct in the Nursing
Process
Step 2: Definition of the Term Moral Conduct (15 minutes)
ASK students to discuss in groups on the term moral conduct for 4 minutes
 Moral: Means rules or ethical habits of conduct, especially of sexual conduct, with
reference to standards of right and wrong
OR
 Is concerned with principles of right and wrong or conforming to standards of behavior
and character based on those principles; "moral sense"; "a moral scrutiny"; "a moral
lesson"; "a moral quandary"; "moral convictions"; "a moral life”
 Moral Conduct: Is the sense of order and human relationship and caring
 Moral principle: Serve as a foundation for moral conduct and reference points for ethical
decision making in nursing.
 Moral reasoning: The interpretive process that helps to connect one’s moral values with
one’s ethical choice
 One may examine the salient features in an ethical situation and makes judgment or
chooses appropriate course of action that are related to moral beliefs and values
Step 3: Types of Moral Principles (30 minutes)
There are four key moral principles which mainly in higher level;
 Principles of respect for autonomy
 Non maleficience
 Beneficence
 Justice
Others are:
 Principle of fidelity,
 Veracity or truth telling
 Confidentiality and privacy
The moral principle of Autonomy

 The principle of autonomy recognizes the rights of individuals to self determination.
 This is rooted in society’s respect for individuals’ ability to make informed decisions
about personal matters.
 Autonomy has become more important as social values have shifted to define medical
quality in terms of outcomes that are important to the patient rather than medical
professionals.
 This makes autonomy an indicator for both personal well-being, and for the well-being of
the profession.

Process
The moral principle of Beneficence
 The term beneficence refers to actions that promote the wellbeing of others.
 In the nursing context, this means taking actions that serve the best interests of patients.
However, uncertainty surrounds the precise definition of which practices do in fact help
patients. Beneficence focus on prevention of harm, remove harm, do good.
 It involves personal, professional and society obligations
The moral principle of Non-Maleficence

 Non-maleficence" is defined by its cultural context.
 Every culture has its own cultural collective definitions of 'good' and 'evil'.
 The concept of non-maleficence is embodied by the phrase, "first, do no harm"
 Many consider that should be the main or primary consideration that it is more important
not to harm your patient, than to do them good.
 So the principle of non-maleficence is not absolute, it balances against the principle of
beneficence (doing good), as the effects of the two principles together often give rise to a
double effect
Conflicts between autonomy and beneficence/non-maleficence

 Autonomy can come into conflict with Beneficence when patients disagree with
recommendations that health care professionals believe are in the patient’s best interest.
When the patient's interests conflict with the patient's welfare, different societies settle the
conflict in a wide range of manners.
 The principles of autonomy and beneficence/non-maleficence may also be expanded to
include effects on the relatives of patients or even the medical practitioners, the overall
population and economic issues when making medical decisions.
The moral principle of Justice

 Justice refers to fairness or to receiving one’s due.
 Is frequently used in allocation and distribution of the scarce resources where there is a
competition for them including health care resources.
 Theories of distributive justice typically address one or all on the benefits of the
distribution and burdens to each person; an equal share according to the individual needs
and efforts and contributions in the society.
Truth-telling
 Some cultures do not place a great emphasis on informing the patient of the diagnosis,
especially when cancer is the diagnosis.
 Knowing the values that are commonly applied to nursing ethics help nurses to
understand what personnel values are and how these values can affect behavior and assist
in delivering quality nursing care.
 Culture may influence individual feelings and way to express herself nurses need to
understand each culture and work in the transcultural era.

Process
Step 4: The Moral Issues in a Health Care Setting (10 minutes)
 Moral issues occur when one failed to observe values and of individual due to certain
circumstance.
 Moral uncertainty: This occur when an individual unsure which moral principles or
values apply and may even include uncertainty as to what the moral problem is,
sometimes referred when the duties and obligations of health care providers are unclear
(moral conflict)
 Moral distress: This is the result when the individual knowing the right to do something
but organizational constraints make it difficult to take the right course of action
 Moral outrage: Occurs when an individual witness the immoral act of another but feel
powerless to stop.
Moral or ethical dilemma

 This occurs when two (or more) clear moral principles apply but they support inconsistent
causes of action.
 It may also described as choosing between more undesirable alternatives and attempting
to select the least damaging from the choices available.
 Nurses should be aware not to negligent patient culture as it has specific customs and
taboos that related to health and life of individual example customs on birth, death, care
of sick, care pregnant mothers, children, adolescent and other groups in the community.
 If a nurse be sensitive to these cultures it will be great value to a patient hence build
optimal therapeutic relationship
 Nurse should use appropriate communication skill to examine the patient perspectives in
relation to culture and its important in health care provision so that to involve and apply it
during care plan
 Nurses should understand their own culture and belief which may influence their
willingness to care for other people
 When moral values are in conflict, the result may be an ethical dilemma or crisis.
 Sometimes no good solution to a dilemma in professional practices.
 What common values applied in nursing ethics?

 Outline the key moral principles
 Explain you solve ethical issues in health care settings

Process
References
W. B. Saunders.
nursing theory and application (6th ed.). USA: Lippincott.
Dar es Salaam, Tanzania.
Wikipedia. (2011). Moral conduct. Retrieved from http://wiki.answer.com

Process
Session 40: Trustworthiness Towards Patients/Clients
Total Session time: 60 minutes
Prerequisites
 None
Learning tasks:
 Adhere to the nurses’ moral conduct during practice
 Explain the trust worthiness and its implication in nursing practice
 Practice openness during delivery of health care
 Demonstrate trust worthiness to patients/clients/coworkers during care delivery
Resources Needed
SESSION OVERVIEW

Tasks
Presentation/ Adhere to Nurses Moral Conduct During
2 10 minutes
Brainstorming Practice
Trust Worthiness and its Implication in
Nursing Practice
5 10 minutes Presentation Openness During Delivery of Health Care
READ or ASK students to read the learning tasks and clarify.


NTA Level 4, Semester 1 212 Session 40: Trustworthiness Towards
Patients/Clients
Step 2: Adhere to Nurse’s Moral Conduct during Practice (10 minutes)
TELL students to pair up and buzz on adherence to nurse’s moral conduct during practice
for 2 minutes.
 Truth telling (veracity) has been described in the patients’ bills of rights as an important
way to convey patients’ information which is supportive in delivering health services.
 It should also recognized that communication is the cornerstone of the nurse-patient
relationship so this emphasizes nurses to be truthful in order to communicate effectively
with patient
 Violation of this principle of conduct show lack of respect, telling lies, avoiding
transparence and lack or responsibility among nurses in health care setting and keeps
them from practicing or participating in useful decision making for patient benefits.
 A professional nurse must fulfill the professional responsibility of being honest and
always telling the truth.
 The nurse is also responsible to report any incompetence, impairments or misconduct of
the colleagues who engage in any fraud.
Step 3: Trust Worthiness and its Implication in Nursing Practice

(10minutes)
 Trustfulness is widely acceptable as a universal practice.

 It is an important function of nurses as it promotes honesty in the whole perspective of
health care professional as it;
o Creates relationships between nurses, clients and all health care workers
o Sharing of knowledge and skills between nurses and their clients/patients
o Improve communications as patient given right information which help in appropriate
decision making
o Increase honesty to health care workers as society are sure with the type of service
provided
o It provide personal integrity and willingness to share one self with others
o Truth telling engenders trust that makes patients to continue to trust nurses and other
health care professionals

Patients/Clients
Step 4: Openness during Delivery of Health Care (10 minutes)
ASK students to discuss in groups on openness during delivery of health care for 4 minutes
 It is well knows that patients do not want to hear bad news that may potential cause harm
to their health.
 Sometime patients are aware of their ill health and other are not, it’s necessary to disclose
all information for benefit of the patient and relatives, thus interpersonal relationship and
cooperation may be maintained through care.
 Ethical when individual is transparency (openness) he/ she also become accountable and
responsible on what has been disclosed to a patients, society or health care setting by
ensuring that all health services delivery requirement are in place and benefit all.
 For professional nurse to be acceptable in health care setting should maintain an

acceptable behavior of truth telling, thus promotes honesty in the whole perspective of
health care professional as it creates relationships between nurses, clients and all health
care workers
 Telling truth is way to increase accountability and responsibility among health workers
Step: Evaluation (5 minutes)
 What are the factors that cause nurses to tell truth during care delivery?
 How you will ensure that the truth telling is adhered in hospital settings?
References
W. B. Saunders.

Patients/Clients
Session 41: Principles of Confidentiality
Prerequisites

 Define the term confidentiality
 Explain the importance of patients confidential information
 Practice confidentiality in delivering services
Resources needed
SESSION OVERVIEW

Tasks
Presentation/
2 10 minutes Define Confidentiality
Brainstorming
Explain the Importance of Patients
Confidential Information
Small group
4 20 minutes Practice Confidentiality in Delivering Services
discussion
Questions and
6 5 minutes Evaluation
Answers
SESSION CONTENT


215
Step 2: Definition of the term Confidentiality (10 minutes)
TELL students to pair up and buzz on adherence to nurse’s moral conduct during practice
for 2 minutes.
Introduction
 Confidentiality is mandated in nursing professional code of conduct.
 Patients give confidential information to nurses voluntarily believing that it will help to
receive correct diagnosis and appropriate treatment from qualified health providers.
 When confidentiality maintained client respect and autonomy is also considered hence the
essence of trust and interpersonal relationship is also maintained.
Definition
 Confidentiality: means process of ensuring that information is accessible only to those
authorized to have access and is one of the cornerstone of information
o Is commonly applied to conversations between health provider and patients.
o This concept is commonly known as patient-physician privilege.
Step 3: Importance of Patients’ Confidential Information (15 minutes)
 Confidentiality is important as it protects patient information and only be used for

confidential purpose only.
 It is practicable that when confidential patient information required consent must be
obtained from individual patient or family
 Patients and clients should also understand that some information may made available to
other members of medical team for planning of care and services, therefore nurses duty is
to maintain confidentiality information that are revealed to them by patients or their
family.
 It is nurse’s obligation to maintain confidentiality by not disclosing the information to
unauthorized people.
Step 4: Practice Confidentiality in Delivery Health Services (20 minutes)

216
Nurses have to practice confidentiality in delivering services through
 Confidentiality and not to disclose the information
 Report incidence to colleagues in the health care team for continuity of care
 Store the information in a confidential manner
 Ensure patient /client signs consent form
 Communicate patient information to authorized health workers only for the purpose of
care plan.
 Practicing confidentiality in the health care setting is very important as it preserves

patient information and facilitates therapeutic relationship.
 It is nurse’s duty to maintain confidential information revealed to them by patients and
moral shared with other health team members in the health care setting for continuity of
care
 What are the importance of confidentiality

 How will you maintain patient confidentiality
References
W. B. Saunders.

217
Session 42: Nursing Ethics and Etiquette
Prerequisites
Learning Tasks
 Define the terms nursing ethics and nursing etiquette
 Explain characteristics of Nursing Profession
 Explain nursing etiquette
Resources needed
SESSION OVERVIEW

Tasks
Definition of Nursing Ethics and Nursing
Etiquette
3 15 minutes Presentation Characteristics of Nursing Profession
Small group
4 20 minutes Nursing Etiquette Rules
discussion
Questions and
6 5 minutes Evaluation
Answers
SESSION CONTENT


218
Step 2: Definition of the Terms Related to Nursing Ethics and Nursing
Etiquette (10 minutes)
 Ethics: Is concerned with judgments about what is right or wrong conduct in relation to
moral conflicts.
 Etiquette: Is the code of behavior that delineates expectations for social behavior
according to the contemporary conversion nouns within a society or social group.
o Is a behavior or manners required in certain places or circumstances
 Liability: Means is the legal responsibility for one’s actions or failure to act appropriate
 Malpractice: Is the improper injurious or faulty treatment of a client resulting in illness
or injury
o Malpractice is the act of doing wrong by professional person
 Assault: The unjustifiable attempt or threat to touch a person without consent that results
in fear of immediately harmful or threatening contact OR,
o A violent action either physical or verbal
 Negligence: Is failure to adhere on the stated rules and principles
 Crime: Serious Law violations where the individual need to be punished
 Tort: Is a less severe wrong doing than a crime
 Consent: Is a signed document for agreement for all routine treatment invasive procedure
such as surgery, chemotherapy and research.
o It provides an individual legal agreement when he is in the care of health care
workers.
Step 3: Characteristics of Nursing Profession (15 minutes)
 It should have a body of organized scientific knowledge and require its members to attain
in preset standards before allowed to practice
 It requires an organized period of extensive study by its members in recognized
institutions of higher learning both theoretical and practical
 It must be founded on a scientific basic, that is its body of knowledge should be derived
from scientific research
 Should have a code of conduct that governing its members and the development of the
profession throughout the life
 A profession is primarily concerned with service to human kind and dedicated in quality
improvement
 It has a professional language which is known and used by its members
 Its existence must be deemed necessary and accepted by the community. It should be
have clear goals aiming at enhancing individual and community development
 It has recognition at national and international levels
 A professional has to grow and develop in line with the scientific and technology changes
 A profession must be self-governing or independent in its functioning. It protects society
from unscrupulous person doing professional practice

219
Step 4: Nursing Etiquette Rules (20 minutes)
ASK students to discuss in groups on nursing etiquette rules for 4 minutes
 Nursing etiquettes are the moral behavior (attitude) found in general ethics which
Individual needs to learn and can be acquired by experience and knowledge of what is
considered as correct and considered bad behavior.
 The observation geared on the set rules and principles of professional practice.
 The professional nurse is expected to demonstrate the following moral standards and
attitudes
o Approach the patients and every person with kindness, and respect regardless of age,
sex, race, or social economic class
o Should always be punctual in performance of any nursing procedure and care
,unpunctuality in any situation may cause to the patients, coworkers and organizations
o Should be dedicated to care with competencies and in excellence
o Should be careful and hard working in service provision
o Be truthfulness –tell true about the patient care
o Should be emotional matured and able to control and cope with any stressful situation
o Must be active and quick but gently in performing procedures
o Should loyal to her profession .coworkers and community – show good characters
o Should polite and respectful to patient and community-address each person by correct
name appropriately
o Maintain body mechanism and alignment when caring patients
o Cultivate a positive work environment- not to shout or any kind of noise in the
hospital setting as it disturbing patients
o Dress successful and maintain good health habits e.g. personal cleanliness, nutritional
welfare, rest and exercises
o Present a positive professional image show love and compassionate care
 Etiquette is the code of behavior that delineates expectations for social behavior
according to the contemporary conversion nouns within a society or social group.
 Nursing profession should have a body of organized scientific knowledge and require its
members to attain in preset standards before allowed to practice
 What is ethics and etiquette?

 What are the characteristics of nursing profession?

220
References

221
Session 43: Patients’ and Service Providers’ Rights
Pre-requisites
Learning Tasks
 Define patients’ rights and service provider rights
 Explain patients’ rights and service provider rights
 Describe ability to adhere to the patients’ rights and service provider rights
Resources Needed
SESSION OVERVIEW

Tasks
Define Patients’ Rights and Service
Providers’ Rights
Explain Patients’ Rights and Service
Providers’ Rights
Presentation/ Describe Ability to Adhere to the Patients’
4 15 minutes
Discussion Rights and Service Providers’ Rights
6 5 minutes Questions and Answers Evaluation
SESSION CONTENT


NTA Level 4, Semester 1 222 Session 43: Patients’ and Service Providers’
Rights
Step 2: Definition of Terms (10 minutes)
Introduction
 The need for clients/patient rights is the largely the results of vulnerability of the
individual because of the existing illness and the complexity of the relationships in the
health care setting.
 When individual person is sick and unable, thus cannot assert his rights as he would if he
was healthy.
 Asserting rights require energy and an underlining awareness of one’s rights in the
situation as a human been.
 Internationally there is patient’s Bill of rights which established in order to promote the
rights of the hospitalized patients.
 In Tanzania client Chatter was established to ensure the national policy and
implementation of the related programs adhere on sufficing the mentioned rights.
 Health care workers are in the position to educate community on their rights while are in
health care provision.
Definitions
 Rights: Is a privilege or fundamental power to which an individual is entitled unless is
revoked by law or given up voluntarily.
 Patient/Client: Is any person who receives medical attention, care or treatment following
illness or injury.
Step 3: Patient Rights and Service Provider Rights (15 minutes)

ASK students to list the patient rights and service provider rights
Patients/Clients rights: The patients’ rights have been derived from the universal
declaration of human rights in order to meet three major goals:
 To help patients feel more confident in the health care system
o Assures that the health care system is fair and it works to meet patients' needs.
o Gives patients a way to address any problems they may have.
o Encourages patients to take an active role in staying or getting healthy.
 To stress the importance of a strong relationship between patients and health care
providers.
 To stress the key role patients play in staying healthy by laying out rights and
responsibilities for all patients and health care providers
 Any person, who visits the health facility or health provider for assistance, once accepted
he becomes a patient who deserves the following rights:
o Be treated with compassion and love.
o Be respected and receive respectful care.
o Be informed of his /her health conditions and prescribed treatment and procedure.
o Privacy and confidentiality of all records and communication regarding his/her care.
o Be informed about the available resources.
Rights
o Refuse services, procedures, activities such as research and treatments which are not
comply with the required standards.
o Be involved in decision making about the treatment and care. The Parents, guardians,
family members, or others can also be involved to choose and speak for patient/client
who cannot make decision for himself e.g. children, unconscious/mental ill patient,
elderly.
o Access to health services, facilities and information regarding to their needs.
o Self-expression and self-determination (consent).
o Be aware with the hospital policy, rules and regulations which apply into his/her care
including cost of the services delivery.
o Complain, review and appeal in accordance with the established policy, rules and
procedures. This includes complaints about waiting times, operating hours, the
actions of health care personnel, and the adequacy of health care facilities
Service Providers’ Rights (Nurses' Bill of Rights)

 Nurses as other health care providers promote and restore health, prevent illness and
protect the people entrusted to their care.
 They work to alleviate the suffering experienced by individuals, families, groups and
communities.
 In so doing, nurses provide services that maintain respect for human values.
o To maximize their contributions to the society, the following rights are placed in the
workplace:-
o Nurses have the right to practice in a manner that fulfills their obligations to society
and to those who receive nursing care.
o Nurses have the right to practice in environments that allow them to act
in accordance with professional standards and legally authorized scopes of
practice.
o Nurses have the right to a work environment that supports and facilitates ethical
practice, in accordance with the Code of Ethics for Nurses and its interpretive
statements.
o Nurses have the right to freely and openly advocate for themselves and their patients,
without fear of retribution.
o Nurses have the right to fair compensation for their work, consistent with their
knowledge, experience, and professional responsibilities.
o Nurses have the right to a work environment that is safe for themselves and their
patients.
o Nurses have the right to negotiate the conditions of their employment, either as
individuals or collectively, in all practice settings. This can be done through
professional Associations like, TANNA, TAMA etc.
o Nurses have the right not to be abused in any form by physicians, pharmacists,
administrators or nursing directors. Any abuse that occurs should be dealt within a
professional and in partial manner by the nurse's employer.
o Nurses have the right not to be exploited and abused by being floated to areas of
practice that they are not familiar with.
o Nurses have the right to rest, leisure time and family life

Rights
Step 4: Ability to Adhere to the Patients’ Rights and Service Provider
Rights (20 minutes)
 In a health care system there are two types of clients namely, internal clients (service
providers) and external clients (patients/clients), that all need to be protected and given
rights, Therefore;
o Patients/service providers’ rights should be in place and followed by health care
providers, patients, society and organization.
o Adequate education and support on the type of stated rights and the availability
o Patients should be expected to take on some responsibilities to get well and/or stay
well.
o Patients are expected to do things like treat health care workers and other patients
with respect e.g. follow the rules and benefits of their health plan coverage.
o Continuously monitoring mechanism on the adherence of the stated rights for both
customers should be in place.

 Health care involves a partnership between patients and doctors and other health care
professionals.
 Open communication, respect for personal and professional standards, and understanding
of differences are important for the best possible patient care.
 Therefore,
o The Hospitals should place patients’ bill of rights with belief that it will add more
effective of care and support.
o Provide a base for understanding and respecting the rights and responsibilities of
patients, their families, doctors, and other caregivers;
o Respect the role of patients in decision making about treatment choices and other
care; and
o Be aware of cultural, racial, language, religious, age, gender, and other differences as
well as the needs of persons with disabilities.
 Hospitals have many functions to perform, including treating injury and disease, health
promotion and prevention, rehabilitation of patients, education of health professionals,
patients, and the community, and research.
 All these activities should be conducted with concern for the values and dignity of
patients by professional nurses and other workers.
 Hence having recognizing the rights for health care providers is important to maximize
their contribution in the organization.
Step 6: Evaluation
 Explain the importance of maintain patient/client rights in the health care facility
 Outline the declared patient/client’ rights
 Outline the declared service providers (nurses’) rights
 Explain how you will ensure that the hospital is adhering to the stated rights for
patient/service providers

Rights
References
W. B. Saunders.
Burkhardt, M. A., & Nathaniel, A. (2002). Ethics & issues in contemporary nursing (2nd ed.).
USA: Cengage Learning

Rights
Session 44: Concepts of Tanzania Nursing and
Midwifery Council
Prerequisites
 None
Learning Tasks
By the end of this session, Students are expected to be able to:
 Define common terms related to TNMC
 Explain the importance of TNMC
 Explain the Roles and Functions of TNMC
 Explain the Relations of TNMC and other councils
Resources Needed
SESSION OVERVIEW

Tasks
2 10 minutes Presentation Meaning of TNMC
3 15 minutes Small Group Discussion Importance of the TNMC
4 15 minutes Presentation Roles and Functions of the TNMC
5 5 minutes Presentation Relationship of TNMC and Other Councils
SESSION CONTENT
Step 1: Presentation of Session Title and Students’ Learning Tasks

(5 minutes)
READ or ASK students to read the students learning tasks and clarify.

NTA Level 4, Semester 1 227 Session 44: Concepts of Tanzania Nursing
and Midwifery Council
Step 2: Meaning of TNMC (10 minutes)
 TNMC is a Professional Regulatory Authority established under “The Reviewed Nursing

and Midwifery Act, 2010” with the mandate to regulate training and practice of the
nursing and midwifery professionals in Tanzania.
 The Council has been established to make provisions for protection, promotion and
preservation of the public health, safety and welfare.
 Historically the Council was set from 1952 and enacted on 1953, several revisions of the
ordinance that governing its activity have taken place.
 The Council is being chaired by a senior registered nurse appointed by the Minister of
Health.
 It has thirteen (13) members representing different sections such as education, nurses
associations, regional nursing officers or district nursing officers, private health providers,
national referral and specialized hospitals, enrolled nurse, the government chief nursing
officer, a nurse educator, state attorney representing the Attorney General’s office and
two members appointed from the public.
 TNMC stands for Tanzania Nursing and Midwifery Council a regulatory body established
under section 4 of the Nursing and Midwifery Act 2010.
 It is a body corporate with perpetual succession and an official Seal.
 It is capable of suing and being sued, holding, purchasing or acquiring in any way any
movable property and disposing of any of its properties.
Step 3: Importance of TNMC (15 minutes)
ASK students to discuss in groups on Importance of TNMC for 4 minutes
 TNMC regulates nursing and midwifery profession by protecting the public in ensuring
that appropriate and effective nursing services are provided.
 It sets standards for nursing and midwifery practices hence maintaining the nursing
profession at the utmost high quality.
 The TNMC ensures that nurses and midwives adhere to professional ethics and etiquettes
at the same time promoting and supporting the advancement of nursing and midwifery
profession.
Step 4: Roles and Functions of the Council (15 minutes)

The Council has several functions such as:
 Register and enroll duly qualified applicants by examination, endorsement, reinstatement
of fulfilling any other requirement.

 Advice the Minister of Health and Social Welfare on matters concerning nursing and
midwifery and to make recommendations on policy matters.
 Ensure that the Register and Roll of nurses and midwives are kept, maintained and
updated in prescribed manner,
 Establish standards of proficiency necessary to be admitted to the different parts of the
Register or Roll,
 Collaborate with other relevant authorities on matters pertaining to nursing and midwifery
education training and practice in approving various standards,
 Evaluate nursing education programs and approve such programs to meet the Councils’
requirement,
 Issue, renew, replace and cancel nursing and midwifery practicing licenses,
 Approve the annual budget of the Council,
 Establish and keep under review the standards of conduct, performance and ethics
expected from nurses and midwives and prospective nurses and midwives and give them
guidance on these matters as it sees fit,
 Caution, censure, order the suspension from practice or order the removal or restoration
from the Register or Roll of the name of any registered nurse or midwife or enrolled nurse
or midwife for malpractice ,negligence or professional misconduct,
 Prescribe uniforms, badges and any other distinctive identities to be worn by nurses and
midwives,
 Prescribe the form of professional oath to be used or administered upon all nurses and
midwives on admission and other profession occasions,
 Prescribe standards and conditions for establishing private nursing or midwifery services
including nursing homes and maternity clinics,
 Grant licenses for establishing private nursing or midwifery services, schools of nursing
or midwifery,
 Develop, conduct and regulate nursing and midwifery registration or enrolment
examination and
 Perform any other functions as prescribed under the nursing and midwifery Act or as may
be directed by the Minister.
Step 5: Relations of TNMC and other Councils (5 minutes)
 TNMC works in collaboration with other professionals in the health sector and in most
cases they also have their Councils.
 Different health professionals work as a team though regulated by different Councils.
 Each member of the team among councils operates as a team in making sure that the
professionals render their services according to the set standards as per specific Council’s
requirement.
 TNMC invites other Council’s comments and suggestions and discussions on matters
pertaining to health for improvement and decision making.
 The Nursing professional is regulated by the law “The Nursing and Midwifery Act, 2010”
The Act makes provision for protection, promotion and preservation of the public health,
safety and welfare.

 Therefore, professional nurses (trained with the specific knowledge and skills) should
adhere on the competencies and ethical rules to ensure the quality of services provided is
of the required standards.
 By doing so the public health will be safe and well protected
Step 7: Evaluation
 What are the importance of TNMC?

 Outline the roles and functions of TNMC
References
Act Supplement.

Session 45: Nursing National and International
Organizations
Pre-requisites
 None
Learning tasks
 Define common profession organization
 List of common professional associations/organizations
 Explain the Roles and Functions of Professional Associations/organizations
Resources Needed
SESSION OVERVIEW

Tasks
2 20 minutes Presentation Professional Organizations
Roles and Functions of the Professional
3 25 minutes Brainstorm
Organization


NTA Level 4, Semester 1 231 Session 45: Nursing National and
International Organizations
Steps 2: Professional Organizations (20 minutes)
Introduction
 Professional organizations are the organs representing the professional members.
 It is responsible to organize all members and coordinate all activities related to the
professional.
 The main goal of organizations is to strive and maintain the highest quality of
professional within the country the member country.
 The work force is conducted by professional members and collaboration with other
international, regional and national partners.
Definitions
International Nurses Organizations
 International Council of Nurses (ICN)
o International Council of Nurses: Is a federation of national nurses associations
currently representing more than 130 member countries and more than 13 million
nurses worldwide.
o The main objective to ensure quality nursing care for all sound health policies
globally, the advancement of nursing knowledge, the presence of respected nursing
worldwide and a competent and satisfied nursing workforce
 International Confederation of Midwives (ICM)
o The International Confederation of Midwives: Is the professional association for
midwives supports, represents and works to strengthen professional associations of
midwives on a global basis.
o At present ICM has 106 Members of all autonomous midwifery Associations in 94
countries.
o The ICN works with midwives and midwifery associations globally to secure
women’s right and access to midwifery care before, during and after childbirth ICM
Mission is to “advance worldwide the aims and aspirations of midwives in the
attainment of improved outcomes for women in their childbearing years, newborns
and their families whenever they reside”
 Regional: East, Central and Southern African college of Nursing ( ECSACON)

o The East, Central and Southern African college of Nursing: Is the professional
body within the Commonwealth Regional Countries within East, Central and
Southern Africa. More than 14 countries are members including Tanzania
Step 3: Roles and functions of professional organizations (25 minutes)

ASK students to discuss about roles of national and international professional organizations

Roles and Functions of ICN
 Promote the organization of national nurses association
 Advice and support professional continuing development
 Assist national nurse association on promoting and improving health services for the
public, nursing education, practice and research
 Provide means of communication among nurses throughout the worldwide as an
authoritative voice for nurses
 Establish relationships and network with other international organizations in order to get
information worldwide on trends and issues, building relationships support others
 Solicit and disburse funds and trust which contributed to nurses for its advancement
 Carry out all activities as outlined to meet the organization stated objectives
Roles and Functions of ICM

 Advance attainment of improved outcomes for women and their newborns
 Strengthen and support midwives and the midwifery profession to be in the best way of
practice
 Ensure achievement of the safe motherhood goals whether directly or indirectly
 Expand the work of midwifery care in order to combat the burden of maternal mortality
 Assist in furthering midwifery education, practice, research and management using
limited funding opportunities for scholarships award and grant provision
Roles and Functions of ECSACON

 Promote quality of nursing education, practice, administration and research for excellence
of profession within the region,
 Ensuring optimum utilization of ideas and experiences within the Region through sharing
in order to improve health status of the community
 Establishing minimum criteria for nursing education, practice and administration
programs
 Promote and support research in nursing
 Ensure maximum utilization of the scarce resources through prioritization of health needs
 Strengthen collaboration and coordination of nursing program/activities in the region
 Facilitate reciprocity for licensure and practice among members state
 Create a unity and make a forum to discuss and speak authoritatively on issues affecting
nursing and health
Objectives and Functions of TANNA
Objectives
 Work for improvement of health standards and availability of quality nursing care service
for all people.
 Stimulate and promote the professional development of nurses and advance their
economic and general welfare.
 Stimulate interest and pride in the nursing profession and to encourage the spirit of unit
and service among nurses throughout Tanzania.
 Represent and promote the views of the association on local, national, regional and
international levels.
 Develop and promote maximum adoption of ethical practices for nurses in Tanzania.

Functions
 Promote standards of nursing practice, nursing research and nursing education in
Tanzania;
 Promote adherence to a code of ethical conduct for nurses;
 Represent and speak for the nursing profession in Tanzania;
 Initiate and influence legislation for the purpose of improving health and promoting the
profession;
 Promote and protect the economic and general welfare of nurses;
 Promote collaborative relationships with other groups in Tanzania that affect health care;
 Serve as the central agency in Tanzania for the collection, analysis, and dissemination of
information relevant to the nursing profession;
 Act on behalf of nurses with regard to promotion of appropriate employment conditions.
 Professional organizations are the organs representing the professional members.

 It is responsible to organize all members and coordinate all activities related to the
professional.
 Serve as the central agency in Tanzania for the collection, analysis, and dissemination of
information relevant to the nursing profession;
 Act on behalf of nurses with regard to promotion of appropriate employment conditions
 Outline the recognized National and international nurse’s organizations

 What are the roles and functions of ICN and TANNA?
References

TANNA. (2005). Constitution. Dar es Salaam, Tanzania.

Session 46: Utilities and Various Levels of Nursing
Prerequisites
 None
Learning tasks
 Define NACTE, and NTA
 Explain the NTA levels qualification framework
 Describe the competence at various levels of nursing
Resources Needed
SESSION OVERVIEW
2 5 minutes Presentation Definition of NACTE and NTA
3 10 minutes Presentation Qualification Framework
4 10 minutes Presentation Competences at Various Levels of Nursing

Presentation/ Duties of Enrolled Nurse and Duties of Registered
5 20 minutes
Buzz Nurse
SESSION CONTENT


NTA Level 4, Semester 1 235 Session 46: Utilities and Various Levels of
Nursing
Steps 2: Definition of Terms (5 minutes)
Introduction
 The NTA qualification as established by NACTE is designed to testify that the holder of the
award is able to apply competently the knowledge and skills described in the relevant
occupational sector.
 The act governing NACTE provides a legal framework for the council to build an
efficient national qualification framework for ensuring that products from technical
institutions are of high quality and respond to changing needs of the country as well as
technological innovations in the world.
 Each NTA qualification has a broad competence level descriptor
Definitions
 NACTE: National Council for Technical Education
 NTA: National Technical Awards, Act No. 9 of 1997 empowers the NACTE “to
establish awards in technical education which are consistent in standard and comparable
to related awards at national and international levels”.
Step 3: Qualification framework (10 minutes)
Level Award
NTA 4 Basic Technician Certificate
NTA 5 Technician Certificate
NTA 6 Ordinary Diploma
NTA 7 Higher Diploma
NTA 8 Bachelors Degree
NTA 9 Masters Degree
NTA 10 Doctor of Philosophy
Step 4: Competences at Various Levels of Nursing (10 minutes)

Level Competence Descriptor
NTA 4
Basic Technician Certificate Aply skills and knowledge at routine level.
NTA 5 Aply skills and knowledge in a range of activities, some of
Technician Certificate which are non-routine and are able to assume operational
responsibilities.
NTA 6 Aply skills and knowledge in a broad range of work activities,
Ordinary Diploma most of which are non-routine.
NTA 7 Apply knowledge, skills and understanding in a broad range of
Higher Diploma complex technical activities, a high degree of personal
responsibility and some responsibility for work of others
NTA 8 Apply knowledge, skills and understanding in a wide and
Bachelor’s Degree unpredictable variety of contexts with substantial personal
responsibility, responsibility for the work of others and
responsibility for the allocation of resources, policy, planning,
execution and evaluation
NTA 9 A stage for professional specialization; graduates may proceed
Master’s Degree for Doctor of Philosophy studies.

Nursing
NTA 10 A stage for contributing to the existing body of knowledge
Doctor of Philosophy through applied research; graduates may proceed with life–
long learning
Step 5: Duties of a Nurse (20 minutes)
Duties of Enrolled Nurse

The following are the general duties for enrolled nurse, tasks assigned should base on job title
of the individual:
 Providing health care services to clients/ patients in hospital, community and elsewhere
services required.
 Co-ordination and supervision of subordinates
 Collect and prepare data related to his/ her work performance.
 Provide home care,
 Counselor- helps client to recognize and cope with stressful psychological or social
problems; to develop an improve interpersonal relationships and to promote personal
growth
 Providing family planning services
 Providing maternal and child health services
 Keep inventory, care of equipment and hospital facilities
 Perform other duties assigned according to the level of education and experiences
 Follow up care, in families and community
 Participate in teaching at schools of nursing and in clinical settings
 Documentation and report writing on nursing and midwifery services
 Cooperates with other sectors including TBAs and Traditional healers aiming at
improving health care services provided to the community
 Provide suggestions on how to improve the quality of nursing
 Participate in developing academic guidelines and regulations
Duties of registered nurse

 The following are the general duties for registered nurse, tasks assigned should base on
job title of the individual:
 Providing health care services to clients/ patients in hospital, community and elsewhere
services required.
 Collect, analyze and interpret data relevant to his/ her working place.
 Provide home care,
 Counseling by helping clients to recognize and cope with stressful psycho logic or social
problems; to develop an improve interpersonal relationships and to promote personal
growth
 Providing family planning services
 Providing maternal and child health services
Nursing
 Health education – provides information and helps the client to learn or acquire new
knowledge and technical skills.
 Keep inventory, care of equipment and hospital facilities
 Providing other duties assigned according to the level of education and experiences
 Follow up care , in families and community
 Participate in teaching at schools of nursing and in clinical settings
 Documentation and report writing on nursing and midwifery services
 Cooperates with other sectors including TBAs and Traditional healers aiming at
improving health care services provided to the community
 Provide suggestions on how to improve the quality of nursing
 Participate in developing academic guidelines and regulations
 Co-ordination, supervision, Monitoring and evaluation of nursing and midwifery care.
 Participate / conduct research in identifying significant researchable problems
disseminate and utilize the results to improve quality of care
 Participate in leadership and management, including planning, making decisions,
coordinating activities of others, allocate resources, evaluate care and personnel
 Creative and innovative in improving health services at located facility
 Prepare working schedule for nursing staff
 Proving preventive services to individual, family and community
 Coordinate and supervise teachings as per need
 Prepare nursing/ midwifery care guidelines at work place
 May be nominated as District nursing officer in charge
 Eligible leader/ manager at hospital, school of nursing, district, regional and ministry of
health
 Provide skilled care at referral level and to critically ill patients
 Able to identify and use appropriate clinical decision making based on nursing process
and
 Provides the necessary advice for proper patient management
 Design and develop modules to improve nursing profession
 Prepare nursing standards for quality of care
 NTA qualification framework as established by NACTE allows graduates to receive

appropriate recognition.
 It is thus intended for producing creative, innovative and flexible technician nurse who
will contribute to national health sector by utilizing appropriately their nursing skills.
 Tasks assigned should base on job title of the individual; each level has specific job
description which will be provided by employer upon recruitment.
 What are NACTE and NTA?

 What are seven levels of NTA qualifications?
 What are the importance of having a job description for each level of nursing?
Nursing
References
MOHSW. (2009) Curriculum information for NTA level 4-6. Dar es Salaam, Tanzania.
NACTE. (2009). Guide for setting qualification standards. Dar es Salaam, Tanzania.

Nursing
Session 47: Advancement and Opportunities
Prerequisites
 None
Learning tasks
 Define common terms
 Explain the importance of continuing education
 Explain remuneration of current nursing profession
 Describe scheme of service for nursing.
Resources Needed
SESSION OVERVIEW

Presentation of Session title and Learning
Tasks
2 15 minutes Presentation Definition of Common Terms
Presentation/
3 25 minutes Importance of Continuing Education
Group Discussion
Remuneration of Current Nursing
Profession
5 25 minutes Discussion Scheme of Service
SESSION CONTENT


NTA Level 4, Semester 1 240 Session 47: Advancement and
Opportunities
Steps 2: Definition of Terms (15 minutes)
Introduction
 The philosophy of developing NTA nursing programmes at level 4- 6 is to provide for a
fairly well developed “stair way” in basic nursing education and competence acquisition,
and therefore advancement is very important.
 It opens the possibilities for moving around and within the NTA qualification frame work
as established by NACTE and allows graduates to receive appropriate recognition.
 This enables the professional Nurse:
o To form a carrier ladder in nursing profession practice, carrier advancement and more
advanced a primary role of nursing management in health care service delivery;
o To steer creativity and innovativeness in response to challenges inherent in nursing
practice and health care delivery
o To stimulate life-long learning behavior for nurses and advancement of nursing
profession
o To provide an international outlook of the learning content and context so as to widen
learner’s advantages into regional and international labour markets
Definitions
 Professional Advancement/ Development: means a comprehensive, sustained, an
approach to improve professionals’ effectiveness in raising worker achievement
 Professional Opportunities: These are working conditions, advancement possibilities

and employment outlook.
o An advancement opportunity is the possibility that you could move up in the
company. Or
o Anything other than what they already have. Or
o Good position, chance, or prospect, as for advancement or success.
Continuing Professional Development:

 Is training carried out during the entire professional life after graduation from basic or
post basic training; it is characterized by self-directed learning and rarely involves close
supervised training for extended periods of time. Or
 Conscious updating the professional knowledge and the improvement of professional
competence throughout a person’s working life.
 It is a commitment to being professional, keeping oneself up to date and continuously
seeking to improve. It is the key to optimizing a person’s carrier opportunities, both today
and for the future.
Continuing Education
 Is any form of education that takes place after completion of the basic training that aims
at improving health and social welfare workers’ performance through updating
knowledge, skills and attitude.
 It is based on health and social welfare workers’ and community needs. OR
 It is the process that includes experiences to facilitate learning after initial or basic
training. OR
 Training undertaken by any individual after the end of the basic training

Opportunities
Step 3: Importance of Continuing Education (25 minutes)
ASK students to discuss in groups on importance of continuing education 4 minutes
 Competencies of health and social welfare workers can be improved and maintained if
they are frequently updated
 It provides capacity building at all levels of care delivery system as it improves their
performance and personnel development
 Health and social welfare worker takes responsibility and duty for self-professional
advancement in order to provide good health care practice and improve quality of care
 Health and social welfare workers are able to acquire learning experiences in their own
environment while providing essential health care to the community
 The programme has a potential of reaching a large number of health and social welfare
workers
 It is cost effective
 It addresses work-based problems so that relevance of what is learned is appreciated and
put into use
 Professional development fosters collective responsibility for improved student

performance and must be comprised of professional learning that:
o It is aligned with rigorous state student academic achievement standards as well as
related local educational agency and school improvement goals;
o It is conducted among educators at the school and facilitated by well-prepared school
principals and/or school-based professional development coaches, mentors, master
teachers, or other teacher leaders;
o Primarily occurs several times per week among established teams of teachers,
principals, and other instructional staff members where the teams of educators engage
in a continuous cycle of improvement that;
o Evaluates student, teacher, and school learning needs through a thorough review of
data on teacher and student performance;
o Defines a clear set of educator learning goals based on the rigorous analysis of the
data;
o Achieves the educator learning goals identified in subsection (A)(3)(ii) by
implementing coherent, sustained, and evidenced-based learning strategies, such as
lesson study and the development of formative assessments, that improve
instructional effectiveness and student achievement;
o Provides job-embedded coaching or other forms of assistance to support the transfer
of new knowledge and skills to the classroom;
o Regularly assesses the effectiveness of the professional development in achieving
identified learning goals, improving teaching, and assisting all students in meeting
challenging state academic achievement standards;
o Informs ongoing improvements in teaching and student learning; and
o That may be supported by external assistance.

Opportunities
Step 4: Remuneration of Current Nursing Profession (40 minutes)
Specialization in Nursing Leads to Career Advancement and Better Remuneration

 Advancement in nursing depends on education, experience, and place of employment.
Registered nurses can become supervisors of departments or specialists in particular
fields of nursing.
 Those with bachelors or master's degrees are more likely to move into higher-level jobs.
Many positions in research, teaching, and administration require master's degrees or even
doctorates in nursing.
 Many nursing jobs are available in the health care sector; but the best are awarded to
those who attained a higher level of education.
 Some jobs are only for registered nurses who have a degree in Bachelor of Science in
Nursing (BSN).
 Leading nursing organizations such as the National hospital, schools of nursing, referral
hospitals, regional and district hospitals.
 Organization of Nurses Association, they acknowledged the importance in the career
progression and provision of adequate patient care
 Salaries for nurses vary with education, experience, and area of specialization.
How nurses can advance their nursing career and why is that even important?
 Nurses perfectly happy in the jobs are currently in and have no desire to advance your
career path.
 Although working conditions vary with the place of employment, nearly all nursing jobs
involve close contact with people.
 Good health and emotional stability are valuable assets.
 Nurses must be careful workers who take their responsibilities seriously.
 They must follow rigid guidelines to ensure the health and safety of themselves and their
patients.
 Registered nurses generally work forty hours per week.
 They may have to work some night and weekend shifts, especially if they work in
hospitals. Many nurses work part time.
Tips for career advancement

 Join and participate in your local nursing organizations:
o There many great benefits to joining your local nursing organizations.
o One of them is networking and meeting people that may help you advance your career
in the future.
o Don't underestimate the contacts you make in local nursing organizations.
 Take advantage of career ladders: ( NACTE qualification frame work)
o Even if you don't want to advance right now, start taking advantage of the career
ladder programs offered at many hospitals and large corporations.
o These organizations have mapped out everything you need to do to advance;
including setting up schedules and free events to help you reach your goals.
o All you need to do is go for it! You may not want it now, but if you decide in two
years to advance at your current location, you will already have met the requirements
if you start today!

Opportunities
 Take advantage of free educational opportunities
o Many hospitals and other companies employing nurses offer free in-services and/or
funds for education.
o Don't let these opportunities pass you by! You can't use the "I can't afford it" excuse
anymore!
o And you should no longer use the "I don't need that class" excuse.
o When it comes to education – especially the free type – you can never get enough!
 Never Stop Learning

o Have you heard that learning is a lifelong process? Well, it's true.
o If you want to continue advancement in your career you will need a higher degree of
education.
o People who succeeded in nursing carrier never stopped taking college courses until
last year when they earned their highest level of nursing education (PhD).
o They continue learning as need arises.
Step 5: Scheme of Service for Nurses in Tanzania (25 minutes)
S/N TITTLE LEVEL SALARY SCALE

CERTIFICATE IN NURSING
1 ENROLLED NURSE II TGHS A
ENROLLED NURSE I TGHS B
SENIOR E/N TGHS C
PRINCIPAL E/N II TGHS D
PRINCIPAL E/N I TGHS E
ORDINARY DIPLOMA IN NURSING
2 ASSISTANT NURSING OFFICER II TGHS B
ASSISTANT NURSING OFFICER I TGHS C
SENIOR ASSISTANT N/O TGHS D
PRINCIPAL ASSISTANT N/O II TGHS E
PRINCIPAL ASSISTANT N/O I TGHS F
BACHELOR DEGREE
3 NURSING OFFICER II TGHS C
NURSING OFFICER I TGHS D
SENIOR N/O TGHS E
PRINCIPAL N/O II TGHS F
PRINCIPAL N/O I TGHS G
 Continuing education and continuing professional development programme ensures that

health and social welfare workers are always knowledgeable and skilful
 Knowledge and skills acquired in basic, post basic and post graduate training withers
away, fades and decays if nothing stimulates the health workers to actively and
continuously learn or search for information

Opportunities
 What is the importance of continuing education in carrier development?
References
MOHSW. (2009) Curriculum information for NTA level 4-6. Dar es Salaam, Tanzania.
NACTE. (2009). Guide for setting qualification standards. Dar es Salaam, Tanzania.

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NMT 04104

United Republic of Tanzania

NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

LCD – Liquid Cristal Display

WHO – World Health Organization

B.C – Before Christ

A.D – Anno Domini

S.R.N – State Registered Nurses

MCHA – Maternal and Child Health Aide

NGT – Nasogastric Tube

NANDA – North American Nursing Diagnoses Association

NMT – Nursing and Midwifery Technician

NTA - National Technical Award

ANA – American Nurses Association

NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

These participants are listed with our gratitude below:

SN Name Title Institution

Dr. Gozbert Mutahyabarwa

NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

Goals and Objectives of the Training Manual

Overall Goal for training manual

Objectives for training manual

NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

Who is the Module For?

How is the Module Organized?

NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

NMT 04104 Nursing and Ethics NTA Level 4, Semester 1

Step Time Activity/Method Content

1 5 minutes Presentation Presentation of Session and Learning Tasks

4 15 minutes Presentation Qualities of Professional Nurse

5 5 minutes Presentation Key Points

6 5 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ/ASK students to read the learning tasks and clarify.

ASK student if they have any question before proceeding

NMT 04104 Nursing and Ethics

DIVIDE students to be divided into small manageable groups

ASK students to provide their responses for 6 minutes after discussion

CLARIFY and summarize by using the contents below

NMT 04104 Nursing and Ethics

The following are the prescribed nursing roles and functions

NMT 04104 Nursing and Ethics

Step 4: Qualities of a Professional Nurse (15 minutes)

 Nursing is considered as a holy profession, serving the human being.

NMT 04104 Nursing and Ethics

Step 5: Key points

 What is the professional nurse?

NMT 04104 Nursing and Ethics

NMT 04104 Nursing and Ethics

Step Time Activity/Method Content

1 5 minutes Presentation Presentation of Session Title and Learning Tasks

5 5 minutes Presentation Key Points

6 5 minutes Presentation Evaluation

Step 1: Presentation of Session Title and Learning Tasks (5 minutes)

ASK students if they have any question before proceed

NMT 04104 Nursing and Ethics

Activity: Brainstorming (10 minutes)

ASK students to brainstorm on the history of nursing in worldwide for 3 minutes

ALLOW few students to provide their responses

WRITE their responses on the flip chart/board

CLARIFY and summarize using the content below