BLUEPRINT REGIONAL EXAMINATION FOR NURSE REGISTRATION CARICOM COUNTRIES

Caribbean Community in collaboration with Canadian Nurses Association The University of the West Indies The University of Guyana, The Ministry of Education-Guyana Pan American Health Organization/World Health Organization Funds from Canadian International Development Agency (ICDS)

TABLE OF CONTENT
Page No
LIST OF ILLUSTRATIONS . ACKNOWLEDGEMENT... INTRODUCTION.. RATIONALE . PHILOSOPHY OF NURSING .. PURPOSE OF THE BLUEPRINT OBJECTIVES OF THE BLUEPRINT . CONCEPTUAL FRAMEWORK . AGREED ON GENERAL COMPETENCIES FOR THE REGISTERED NURSES IN THE COMMONWEALTH CARIBBEAN OUTLINE OF THE MAJOR CONCEPTS OF THE BLUEPRINT 1. 2. 3. 4. 5. Growth and Development . Needs . Factors Affecting Needs Satisfaction Common Health Problems of the Caribbean . Nursing Process . 13 13 14 12 12 iv v 1 2 3 5 6 7 9

MAJOR CONTENT AREAS A. B. Man and His Environment .. Nursing 16 21

CONTENT OUTLINE Biological and Psychosocial Factors Promoting and Maintaining Needs Satisfaction Throughout the Life Cycle APPLICATION OF THE NURSING PROCESS TO INDIVIDUALS WITH BASIC NEEDS INTERFERENCES Outline . Example I: Needs Interferences of the Pre-School Child (1-4 years) (Gastro-Enteritis) .. Example II: Needs Interferences of the School-Child (5 11 years)(Learning Disabilities) .. Example III: Needs Interferences of the Pregnant Adolescent (12 19 years)(Pregnancy) .. Example IV: Needs Interferences of the Young Adult (20 44 years)(Hysterectomy) (Fibromyoma of Uterus) . Example V: Needs Interferences of the Young Adult (20 44 years)(Hyperactivity) (Anxiety Neuroses) . Example VI: Needs Interferences of the Adult (45-64 years) (Diabetes Mellitus) . Example VII: Needs Interferences of the Older Adults (65 + years) (Senility) . GUIDELINES FOR DEVELOPING THE TABLE OF SPECIFICATIONS . TEST ITEMS ..

25

30

40

41

45

51

57

62

68

73 78 83

ANNEX I, TABLE I: COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES ANNEX II, TABLE II: CORE LIST OF NURSING SKILLS FOR SCHOOL-BASED ASSESSMENT . ANNEX III: GUIDELINES FOR THE USE OF CORE LISR OF NURSING SKILLS FOR ASSESSMENT OF CANDIDATES . ANNEX IV: CRITERIA FOR CLINICAL ASSESSMENT .. ANNEX V, FIGURE I: COMPONENTS OF THE BLUEPRINT ANNEX VI, FIGURE II: SAMPLE TABLE OF SPECIFICATIONSBLUEPRINT COMPONENTS .. ANNEX VII: GLOSSARY ANNEX VIII: BIBLIOGRAPHY ANNEX IX: MAP OF CARICOM MEMBER COUNTRIES .

84

94 102 106 108

110 112 115 117

LIST OF ILLUSTRATIONS
ANNEX I, TABLE I: COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES ANNEX II, TABLE II: CORE LIST OF NURSING SKILLS FOR SCHOOLBASED ASSESSMENT . ANNEX III: GUIDELINES FOR THE USE OF CORE LIST OF NURSING SKILLS FOR ASSESSMENR OF CANDIDATES . ANNEX V, FIGURE I: COMPONENTS OF THE BLUEPRINT . ANNEX VI, FIGURE II SAMPLE TABLE OF SPECIFICATIONS .. ANNEX IX: MAP OF CARICOM MEMBER COUNTRIES

84

94

102 108 110 117

ACKNOWLEDGEMENT
The Regional Nursing Body acknowledges with gratitude the assistance received from the following organizations in developing this Blueprint: Caribbean Community Secretariat Canadian International Development Agency (NGO) Ministry of Education, Guyana Pan American Health Organization/World Health Organization University of Guyana University of the West Indies

Contributions made by Ministries of Health, Ministries of Education, General Nursing Councils and nurses of the participating countries are also acknowledged. This Blueprint is dedicated to the memory of Miss Evelyn Patterson, Lecturer, Advanced Nursing Education Unit, University of the West Indies, Mona Campus, for her excellent contribution and untiring effort in its preparation. Dr. Una V. Reid Advisor HMD PAHO/WHO January 1992

INTRODUCTION
In all the CARICOM territories there exist certain conditions that seem to favor the establishment of a Regional Examination for Professional Nurse Registration. These conditions include common health problems, similar nursing education programmes, similar nursing practice and supporting infrastructure and, above all, the need to enhance the effectiveness of the nursing care available to the peoples of CARICOM territories. The Regional Nursing Body, therefore, in its objectives developed in 1976, placed the development of a Regional Examination for Professional Nurse Registration. A feasibility study was carried during October and November 1976 and established the fact that 13 Commonwealth Governments in the Region agreed, in principle, to a Regional Examination for Professional Nurse Registration. A workshop at Dover, Barbados, in 1978 provided a document, which included common aspects of nursing considered essential for nurses seeking registration in the Region. The Dover Document formed the background material for the development of the Blueprint. There were subsequent activities in the further development of the Project. The General Nursing Councils met at the Ocean View Hotel, Barbados, in 1990 to develop strategies for the implementation of the examination. The representatives identified twenty-four(24) competencies as the scope of practice for all registered nurses awaiting to practice nursing within the CARICOM Member states. Under the Canadian Nurses Association (CAN) sponsorship, the Canadian International Development Agency (CIDA) approved the funding of the Regional Nurse Registration Project until 1985. Funding for subsequent Project activities were also provided by the Pan American Health Organization (PAHO) and CARICOM. PAHO continues to support the Project. The Blueprint, therefore, is the result of the activities of nurses of the Region who attended a series of workshops between November 1980 and 1991. The philosophy, goals, objectives, competencies and content outline of nursing and the relevant supporting sciences. It provides a ready reference on a Regional Professional Nurse Registration Examination.

RATIONALE The rationale for the Regional Examination for Professional Nurse Registration is to: 1. Establish a uniform standard of testing and evaluating nursing students for nurse registration in the Caribbean. 2. Foster the implementation of a uniform testing policy (passing, failing and writing examinations). 3. Provide adequate security for production and administration of examination 4. Institute continuing research an examinations and examinations policies. 5. Provide data for evaluating curricula for Schools of Nursing. 6. Benefit individual tutors and administrators in developing their competency in testing and evaluation. 7. Facilitate the emergence of a system for reciprocal registration of nurses in the Region 8. Provide quality examinations in the Region through the cooperation of General Nursing Councils of the Caribbean Countries.

PHILOSPHY OF NURSING
The nurses of CARICOM Member countries believe that

MAN
1. Man is a bio-psycosocial being who has basic needs which are physical, social, spiritual and emotional. 2. The extent to which mans needs are satisfied determines the status of his health along the health-illness continuum. 3. The health status of man is affected by environmental, biological, psycosocial and lifestyle factors as well as by the health care system. 4. Man has a right to optimum health, health care and social services for himself and his family.

FAMILY
5. Community is made up of family units, which interact within socio-cultural, political and economic boundaries, and the community shares common values, beliefs and practices.

HEALTH CARE
6. Health care is a priority for individuals, families and communities. 7. Access to quality health care is a basic human right, 8. Health care should be accessible, acceptable and available to each individual regardless of his/her ability to pay. 9. Health care should be comprehensive, continuous and coordinated, at primary, secondary and tertiary levels. 10. Health care should be provided within the resources of the community. 11. The individual shares responsibility with the health care system for the maintenance of his health, his familys health and that of his community. 12. Quality health care requires the participation of the community in assessing, planning, implementing and evaluating health programmes. 9

NURSING
13. Nursing is a profession 14. Nursing is a key element in the provision of comprehensive health care in primary, secondary and tertiary health care settings. 15. Nursing contributes in a unique way to the delivery of health care through its caring role. 16. Nurses function independently, inter-dependently and dependently within the multidisciplinary health team. 17. The nurse functions as a clinician, educator, administrator/manager/change agent, researcher and public/community relations officer in any health care setting.

NURSING EDUCATION
18. Nursing education allows for the acquisition of knowledge, skills, attitude and problemsolving techniques necessary to assist clients in meeting their health needs. 19. Testing and evaluation skills are important in the method of assessing the competency of the graduating professional nurse.

10

PURPOSE OF THE BLUEPRINT

The purpose of the Blueprint is to provide a uniform structure from which a standard testing instrument can be developed and used among other methods to determine eligibility of graduates of nursing programmes to practice professional nursing in CARICOM countries.

OBJECTIVES OF THE BLUEPRINT

The Blueprint for Regional Examination for Nurse Registration: 1. Provides the basis for the development of assessment tools for regional professional nurse examinations; 2. Outlines the cognitive, affective and psychomotor domains to be tested; 3. Shows the inter-relationships of areas to be tested; 4. Outlines primary, secondary and tertiary levels of nursing and health care; 5. Identifies common health problems in the Caribbean; 6. Categorizes common health problems in the Caribbean; 7. Delineates the critical elements and nursing competencies to be tested; 8. Specifies relevant scientific content essential to the practice of nursing; 9. Establishes the parameters and standards for the professional nurse exam nations.

11

CONCEPTUAL FRAMEWORK
There are certain biological, psychosocial, environmental and lifestyle factors which have positive and negative effects on mans health status and on his needs alleviation of the negative effects of these factors on mans health and that of his family and community, fall as a joint effort between man and the health care system. Nursing assists man and his family to promote and maintain health. Nursing also intervenes when man and his family are unable to cope unaided with the factors affecting health status and needs satisfaction. The goal of nursing intervention is for man and his family to achieve self-reliance in health care. The Blueprint reflects nursing as unified and integrated. Nursing practice, as portrayed in the Blueprint, brings together concepts from clinical and functional nursing competencies as well as the biophysical and behavioral sciences. The nursing process is the toll used as the basis for providing unified, integrated, and comprehensive nursing care to individuals, families and communities within a multidisciplinary team. Examples showing the use of the nursing process are included in the Blueprint. Each example is designed to illustrate how the factors affect needs satisfaction of the individual. Critical elements of needs interferences and the critical areas of care, using and integrated and team approach to care, are also identified in the examples. In developing case studies for examinations, the critical elements of needs interferences and the critical areas of care must be considered in relation to stages of the life cycle and the health status of the individual. Example III (page 63-69), illustrates these principles. The major concepts of the Blueprint are: 1. Growth and development 2. Needs 3. Factors affecting needs satisfaction 4. Common health problems of the Caribbean 5. Nursing process

12

The major content areas of the Blueprint to be tested are: A. B. Man and his Environment Nursing 1. Clinical nursing 2. Nursing process

Functional nursing Profession of nursing Administration of Nursing Research Teaching, Interviewing and Counselling

For testing purpose, these concepts and content areas may be treated singly, as well as in an integrated way.

AGREED ON GENERAL COMPETENCIES FOR THE REGISTERED NURSE IN THE COMMONWEALTH CARIBBEAN
1. Use the problem-solving approach to: (a) assess the health care needs of individuals of all age groups and families in any health care setting. (b) plan health care for individuals and families within the community based on identified and potential problems and needs; implement plan care to assist individuals, families and communities to cope with actual and/or potential problems;

(d) evaluate the effectiveness of nursing care based on stated objectives.

2.

Provide safe and competent nursing care to all age groups at all levels of health in he wellness/illness continuum in varied settings. 13

3. 4. 5. 6. 7. 8. 9. 10.

Apply knowledge of the bio-psychosocial, spiritual and environmental factors in the delivery of health care. Communicate effectively with co-workers, individuals and families on matters related to health care for the promotion and maintenance of optimum health. Demonstrate interpersonal skills that enhance the functions of the health team Utilize principles and skills of management in administering health care units. Demonstrate leadership ability and skill in the management of health care services. Perform teaching functions in relation to the development of colleagues, students and auxiliary health workers, and in relation to patient-centered and family-centered care. Provide guidance and counseling in prevention illness and promoting health and rehabilitation. Function as a member of the interdisciplinary health team in the provision of comprehensive health care in a variety of health care settings. Demonstrate understanding for national policies and their implications for nursing. Apply research knowledge and skills to study and/or solve nursing and health problems. Maintain competence in nursing practice through continuing education and self-directed learning. Demonstrate a caring attitude in providing nursing care to individuals, families and communities. Participate in the formulation, implementation and evaluation of standards of patient care. Motivate the community and its members to participate actively in the health care delivery system. Coordinate with other sectors in the provision of health care for individuals, families and communities. 14

11. 12. 13.

14.

15. 16.

17.

18. 19. 20.

Participate in community activities in carrying out his/her responsibilities as a professional nurse and a citizen. Demonstrate competence in screening individuals, families and communities with a view to applying appropriate nursing intervention and/or initiating relevant referral. Exhibit concerns for the rights of the individuals in relation to health care, within the ethical and legal frameworks, which are congruent with rules governing the practice of nursing. Initiate change to improve the quality of nursing practice and the delivery of health care.

21. 22.

Recognize the value of participating actively in the professional organizing for the advancement of the Profession. 23. 24. Assume responsibility for his/her own actions within the scope of nursing practice. Recognize the role and contribution of national, regional and international organizations, and nursing personnel, in the development of nursing.

OUTLINE OF MAJOR CONCEPTS OF THE BLUEPRINT 1. Growth and Development

For purposes of the Caribbean Blueprint, the following age groupings are identified: Infant to Pre-School Child 1 month 4 years School Child 5 11 years Adolescent 12 19 years Young adult 20 44 years Adult 45 64 years Older Adult 65+ years

2. Needs
Needs are common to individuals at all stages of the life cycle. Satisfaction pf these needs are essential for physiological and psychosocial well-being. For purposes of the Blueprint, the needs identified are:

15

Physiological
Oxygen Nutrition Elimination Activity, rest, comfort Sensory stimulation Safety and security Sexuality

Psychosocial
Love and belonging Trust Self-concept Self-esteem Self actualization

3. Factors Affecting Needs Satisfaction

These are conditions that bring about a change in mans health status. There are four factors, namely: Biological Psychosocial Environmental Lifestyle

4. Common Health Problems of the Caribbean

Health problems are conditions which result from needs interferences. For purposes of the Blueprint, the health problems are categorized as follows (See Table I):

Congenital
Defects of structure and/or functions existing at, or appearing after birth.

Genetic
Defects of structure and/or functions existing at, or appearing after birth due to disorders of genes/chromosomes.

16

Infectious/Inflammatory
The reaction of the body to toxins and invasion by micro-organisms.

Infestations
Invasion of the body by microbes and parasites.

Allergic/Immunological
Abnormal reaction of the body to the entry of foreign substances.

Neoplastic
Benign or malignant proliferation of cells.

Accident/Trauma
Damage to tissues resulting from injuries.

Metabolic/Nutrition/Endocrine
Changes, which result from absence, decrease/excess of hormones, enzymes and nutrients.

Degenerative
Disturbances due to deterioration in cellular structures and functions.

Psychosocial/Psychiatric
Disturbances characterized by distorted social, emotional and/or intellectual behaviour.

Environmental
Imbalances in the environment.

Health Infrastructure
Types and availability of health and health-related services and human resources.

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5. Nursing Process
The nursing process has the following four phases: 1. Assessing Take and record nursing history from individuals and significant others Refer to medical data Perform physical examination Study the data collected Interpret the findings of the data

2.

Planning Formulate nursing diagnoses Assign priority to nursing diagnoses Establish problem list Specify short-term and long-term goals Identify appropriate nursing actions Establish outcome criteria Develop written plan of care Involve the individual, family and significant others Review the plan of care

3.

Implementing Activate nursing care plan promotive, preventive, restorative/curative, rehabilitative Coordinate care activities Record and report responses to nursing actions Maintain continuity of care Refer to appropriate agency(ies)

4.

Evaluating Collect data Compare to individual, family, community responses with expected outcome criteria Determine extent to which goals are achieved Identify alterations that need to be made in nursing diagnoses, goals, nursing actions and outcome criteria Modify the nursing care plan accordingly 18

Implement the modifications MAJOR CONTENT AREA

The goals, objectives, and content included in this Section form the syllabus to be tested in the examinations. A. Goal Demonstrate knowledge of relevant concepts of the biophysical and behavioural sciences in relation to man and his health.

Man and His Environment

a)

Bio-Physical Sciences
Objectives 1) Explain the role of the cell in metabolic activities of the body. 2) Demonstrate knowledge of homeostasis. 3) Discuss the principles underlying good body mechanics. 4) Demonstrate knowledge of neutral and hormonal regulation of body activities 5) Describe the immunological response of the body and relate the role of immunity in body defense 6) 7) 8) 9) Demonstrate knowledge of cardiac and circulatory dynamics. Discuss the process of metabolism Explain the process of reproduction. Demonstrate knowledge of mechanisms of inherited characteristics. 10) Explain the conditions, which predispose the individuals to the invasion and multiplication of microbes and parasites. 11) parasites. Discuss measures used in prevention and control of microbes and 19

12) 13) 14) 15) health.

Content Outline

Discuss the concepts and principles of nutrition and related diet therapy. Demonstrate knowledge of the categories and effects of select drugs. Describe the principles and laws, which govern storage and use of drugs. Demonstrate knowledge of ecological factors and their relationships to

I. II. III. IV. V.

Human Biology, Biochemistry, Biophysics Microbiology Nutrition Pharmacology Ecology

Broad Concepts
Move ment of body water Fluid and electrolyte balance (g) Immunological Response ity ensitivity immunity (h) Process of Reproduction nisms of heredity ation tation Immun Hypers Auto-

(a) Cell Functions (b) Concept of homeostasis (c)Movement of body and mechanics Muscul o-skeletal Nervou s (d) Energy Exchange (e)Cardiac and Circulatory Dynamics Volum e Output (f) Diffusion and Osmosis ge of gases Exchan

Mecha Fertiliz Implan 20

 development

Foetal

(ix) Metabolic Process Ingesti on Digesti on Absorp tion

on lation ation

Secreti Assimi Elimin

(i) Sensation and Integration Neural, hormonal and sensory regulations

II. Microbes and Parasites III Nutrition needs, energy and nutrients. IV. Pharmaco-Dynamics VI. Ecology (a) Effects of Urbanization and Industrialization Pollutants and their effects on air, water, land and space Monitoring and control of pollutants and pollution 21 Categories of drugs Drug actions Indication of drugs Adverse responses to drugs Variables influencing drug actions Storage of drugs Drug standards and legislation Types, sources and functions of foods and nutrients Nutritional needs and individuals along the life cycle Concepts of diet therapy, modifications of normal dietary Growth conditions Modes of transmission Control measures

(b) Effects of Natural and Man-Made Disasters

b)

Behavioural Sciences Objectives

1. Demonstrate knowledge of Caribbean family structure and functions. 2. Analyze the effects of social organizations and institutions on family life in the Caribbean. 3. Demonstrate knowledge of community dynamics and their effects on the health status of man. 4. Recognize normal patterns of growth and development at all stages of the life cycle. 5. Demonstrate understanding of the interrelationships of the basic needs of man (e.g., Maslow) 6. Describe the developmental tasks of individuals at different stages of the life cycle (e.g., Erikson). 7. Explain dynamics of human behaviour. 8. Understand theories of personality development (e.g., Freud, Adler, Sullivan) 9. Discuss principles and theories of learning (e.g. Piaget, Skinner) 10. Demonstrate methods and techniques of behaviour modification. 11. Describe methods and techniques of behaviour modification. 12. Describe the principles of interviewing and counseling.

Content Outline
I. Sociology II. Psychology 22

I. Broad Concepts i. Caribbean Family Structure and Functions ii. Factors affecting Family Units 1. Cultural beliefs and practices 2. Social organizations and institutions Political Educational Economic Religious 3. Socioeconomic iii. Community dynamics II. Psychology i. Theories of Growth and Development ii. Developmental Tasks iii. Needs Theory iv. Theories of Personality Development v. Dynamics of Human Behaviour vi Principles and Techniques of Behaviour Modification vii. Principles and Theories of learning viii Principles of Interviewing and Counseling B. Goals 1. Demonstrate technical and professional competence in the provision of nursing care to individuals, families and communities through integration of knowledge of the biophysical and psychosocial sciences and the use of the nursing process. Nursing

23

2.

Display behaviour, which reflects the accepted criteria for the profession, and recognize the practice of nursing as an intellectual discipline, which requires commitment to service and a positive attitude towards learning as a life long responsibility.

Objectives 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Demonstrate knowledge of concepts of health Determine factors that affect health of individuals, families and communities. Assess the health status of the individual, groups and community, using the epidemiological approach. Describe disease surveillance including sources of surveillance information and is utilization in the planning and evaluation of health programmes. Use appropriate community resources in the provision of health care at primary, secondary and tertiary levels. Apply knowledge of growth and development in the provision of health care Describe the assessment of clients who have interferences of physiological and psychosocial needs. Discuss factors which alter the capacity of clients to satisfy physiological and psychosocial needs (e.g., lifestyle, environmental, psychosocial, biological) Discuss effects of alterations in needs satisfaction to clients health status (e.g., fluid and electrolyte imbalance, shock, malnutrition, disturbed behavior patterns) Discuss the most common types of disturbed behaviour patterns evidence among Caribbean peoples. Discuss measures which will assist clients to cope with alterations meeting physiological and psychosocial needs. Explain the several treatment modalities used to correct needs interferences Interpret values of selected diagnostic tests in relation to specific health problems Collaborate with other team members, sectors and agencies in providing care for individuals, families and communities. 24

15. 16. 17.

Coordinate with other team members, sectors and agencies in establishing appropriate referrals of clients. Explain the dynamics in a community, which facilitate or hinder community participation. Establish priorities and plans for intervention with individuals, families and communities based on analysis, community expectations, accepting standards of practice and available resources. Determine priority care for high-risk individuals and vulnerable groups. Design health programmes for special groups (e.g., workers, aging and disabled) Plan health education programmes, which will assist individuals, families and communities to assume responsibility for their health. Demonstrate knowledge of causes and effects of disequilibrium between individuals and their environment. Integrate knowledge of bio-physical and behavioral sciences in the nursing care of clients with health problems. Demonstrate knowledge of the responsibilities of the nurse in disaster management Demonstrate ability to prioritize in emergency situations. Assist individuals, families and communities to develop skills to cope with and to take responsibility for their health care. Execute health and family life education programmes for individuals, families and communities. Design education programmes which emphasize promotion of health prevention of illness, restoration and rehabilitation. Demonstrate beginning skills in developing, implementing and evaluating teaching plans for individuals, families and communities. Describe roles and functions of health, health-related and social organizations and agencies in the Region. Demonstrate professionalism in the practice of nursing. Adhere to the legal and ethical standards in the practice of nursing 25

18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31.

32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44.

Explain implications of health laws in relation to health care individuals, families and communities. Demonstrate knowledge of manifestations of pregnancy and of assessment and care of the woman, neonate and family throughout the maternity cycle. Explain physiological and psychosocial changes in individuals and families in relation to pregnancy. Discuss measures that will foster parental bonding. Discuss the developmental tasks of families in relation to child-bearing and child-rearing practices. Identify actual and potential problems that may occur in the pre-natal intranatal and post-natal periods and their related management. Discuss the nurses role in the management of clients with specific health problems. Apply basic principles and techniques of administration/management nursing situations. Use communication skills in recording and reporting client information. Apply basic research methodology in solving health problems Examine results of health care for individuals, families and communities in terms of achievement of expected outcomes. Demonstrate the ability to perform safe nursing care. Participate actively in community affairs.

Content Outline Nursing I Health Primary Secondary Tertiary iv. Levels of Health Care Primary Secondary Tertiary

i. Concepts of Health ii. Epidemiological Approach iii. Levels of Prevention

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II Growth and Development i. ii. Stages in the Life Cycle Developmental Tasks

III. Needs and Their Satisfaction Along the Life Cycle i. ii. Physiological Psychosocial

IV. Factors Affecting Needs Satisfaction/Health i. Biological Physiological functions

ii.

Psychosocial Coping behaviour Socio-cultural Political Economic Population dynamics

iii. Environmental Ecology Housing Vectors Sanitation iv. Lifestyle Substance abuse Health practices Dietary habits Hobbies Religious practices Work habits V. Needs Alterations Loss Stress Changes in body image Pain Sensory deprivation Immobility 27

Fluid and electrolyte imbalance Disturbed patterns of behaviour

VI. Indicators of Community Health Socio-politico-cultural environment Economy Ecological and environmental conditions Disease prevalence Groups at risk Lifestyle of groups Community resources Health legislation Population dynamics Community dynamics Availability, accessibility and utilization of health-related services VII. High Risk Individuals and Groups, Including Emergencies VIII. Health Programmes for Special Groups School health Occupational health Services for the elderly, the disabled and others IX. Role of the Nurse in Disaster Preparedness and Management Pre-disaster planning Mobilization of resources Management of mass casualties o First aid o Triage o Crisis prevention o Post-disaster planning o Record keeping o Post-disaster surveillance X. Group Dynamics Group process XI. Teaching and Learning Process Principles of teaching and learning Principles of adult education Principles of health teaching and counseling XII. Communication Process Principles 28

Techniques Therapeutic communication Interviewing Reporting Recording

XIII. Health and Families Life Education Family relationships Preparation for parenthood Family spacing Sexuality Single parent family Preparation for the retirement

XIV. The Profession of Nursing i. Factors influencing the development of nursing: Political Socio-economic Technological Scientific ii. Ethical and legal practice of nursing iii. Professional organizations

XV. Health and Health-Related Organizations and Agencies at National, Regional and International Levels Governmental Non-governmental Private voluntary

XVI. Family Unit Developmental tasks XVII. Pregnancy i. Changes in family unit due to pregnancy o Psychosocial o Physiological ii. Manifestations of pregnancy 29

iii. Health appraisal and care throughout the maternity cycle iv. Complications and conditions of pregnancy in the internatal and postnatal periods

XVIII.Administration/Management Principles and techniques of administration and management Elements of supervision Change process XIX. Application of Basic Research Methodology in Solving Health Problems Steps in research methodology Factors affecting quality of research Application of research process to nursing practice XX. Biological and psychosocial Factors Promoting and Maintaining Needs Satisfaction Throughout the Life Cycle A. Assessing (to be used for all age group 1. Biographical Data of Family Health history Hereditary patterns Familial tendencies 2. Biographical Data of Individual Age Address, etc. Education Occupation Hobbies 3. Physiological i. Oxygen Circulatory status: o Body temperature range o Characteristics of apex pulse rates o Characteristics of blood pressure Respiratory status: o Characteristics of respiration 30

o Rate of breathing o Patency of airway ii. Nutrition Eating patterns Appetite Food fads Diet Food hygiene and preparation Weight o Normal o Underweight o Overweight Height Oral health o Dentition o Condition of mouth, lips, teeth, breath o Ability to masticate Bladder status Bowel status

iii. Elimination Skin integrity iv. Sexuality Grooming Condition of external genitalia Family planning practices Pubertal changes Psychosexual development v. Activity and Rest Sleep pattern Use of supportive aids, e.g., drugs Current mobility status

Male/female relationships Pattern of menses Menopause male and female Condition of breasts Coordination Type of exercise Posture and gait Range-of-joint movements Coordination

vi. Sensory Simulation Status of special senses o Vision o Hearing o Speech Status of environment (stimulating/non-stimulating) vii. Safety and Security

o Taste o Smell o Touch

31

Safety precautions at home, school, with environment, roads, etc. Personal hygiene o Skin o Hair o Nails Clothing and footwear Skin integrity Mucous membrane integrity Immunizations Immunological response

4. Psychosocial Individual: i. Love and Belonging Family, spouse, peer, other relationships Individual and family support system(s) Ability to give and accept love Capacity for adjustment and adaptations ii. iii. Trust/Security Status of developmental tasks according to stage of life cycle Self-Concept and Self-Esteem Level of cognitive/intellectual development Peer and other relationships Feelings about self Measure of self-esteem and acceptance of body image Independent thinking and action Self-Actualization Career (and other) goals and ability to achieve these Problem-solving ability and coping with stress Socio-Economic Occupation Financial status

iv.

v. vi.

Socio-Cultural Beliefs and customs influencing health Family: i. Family Membership (include all persons/relatives household) Name Age 32

ii.

Religion Position, role in the family Scholl or work of each member Extended Kinship Network Father Mother

Children Grandpar ents

Aunts/uncles Other

iii.

Living Conditions Amount of physical space in house Income and socio-economic level Neighborhood life (i.e. safety, housing conditions, availability of resources) Work Employment stability of breadwinner Job satisfaction o Fat o Mot her her Work schedule (to permit family interactions) Family budget

iv.

o Oth er

v.

School Educational background of parents Academic achievement of school-age children Behavioural conduct of school-age children School (teacher/family relations)

vi.

Recreation Time spent in family activities together (including meals), hobbies, individuals outside interests of family members Fathe Moth Child r er ren Social Welfare Agencies Involvement with legal system (police, court, jail) Dependence on income supplement, welfare Medical care of family members Mental health care o Fath o Mot er her

vii.

o Chil dren 33

5. Environmental i. Home Environment o Cleanliness Ventilation o Adequacy Water o Source of supply o Adequacy o Safety Electricity o Presence Lighting o Adequacy Privacy o Number of rooms in house o Number of people in home o Sharing of facilities/space in home Solid wastes o Dry Method of disposal Adequacy Wet o Method of disposal

Sewage disposal Vectors o Presence o Control Drainage (around home) o Effectiveness Sanitation o General sanitation Telephone, radio, television

o Presence o Programmes on radio and television and possible side effects Newspapers o Availability of newspapers in the home and work Postal services o Home delivery o Postal collection Roads o Adequacy and/or accessibility o Availability Safety o Floors o Electrical outlets, plugs o Rugs o Handrails o Locking devices o Adequacy of storage, use and disposal of: Toys Drugs Detergents Insecticides Other chemicals Food o Storage o Food and milk hygiene

ii. Community Cleanliness of streets, public facilities, etc., Presence of recreational facilities Presence of parks Air Pollution from traffic, factories, other Water Type of supply Adequacy Safety Housing Types Adequacy Electricity Presence of supply

Solid wastes Dry o Method of disposal Wet o Types of disposal o Adequacy Sewage disposal Drainage (streets) Effectiveness Telephone, television, radio Presence of radio, television, public telephones Safety Community o Supervision in swimming pools o Presence of safety railings on roads, bridges, etc., o Cleanliness of public conveniences, roads, pedestrian crossings, sidewalks Industry o Use of protective devices o Ecology o Pollutants and types 6. Lifestyle i. Cultural beliefs about health, child rearing practices etc., ii. Hobbies iii. Use of leisure time iv. Use of substances v. Alco hol Tobacco Drugs Others

Methods of coping with stress and use of support system(s)

vi. Religious beliefs B. Planning Planning nursing interventions to support individuals and familys ability to promote and maintain health.

C. D. XXI

Implementing Interventions to promote and maintain health/basic needs achievement. Evaluation Evidence of change in health behaviour necessary to promote and maintain health. Health Teaching/Counseling 1. Genetic Counseling 2. Physiological i. Oxygen Maintain body temperature Erect posture for better chest expansion Prevent respiratory infections ii. Nutrition Nutrition education and counseling to include: Oral health practices Appropriate nutritional requirements and food for age Family budgeting for food Food hygiene and preparation Growing backyard gardens Norms for height and weight Maintain appropriate weight for age iii. Elimination Appropriate fluid, food and exercise to develop and maintain bowel and bladder activity iv. Exercise and Rest Planned physical activity Period of time for rest Recommended number of hours of sleep per age group Sleep pattern Aids to sleep

v. Sensory stimulation vi. Stimulating environment (home, school, work) Play opportunities Visual and tactile stimulation

Sexuality Satisfactory male/female relationships

 Peer group relationships Opposite sex relationships Grooming and sexuality Sexual behaviour Sex and family-life education vii. Safety and security Immunizations according to age Methods of accident prevention on roads, in home, school, workplace Personal hygiene 3. Psychosocial i. Love and belonging Supportive family, spouse, peer and other relationships Developing capacity to love and accept love ii. Trust and Security Achieving developmental tasks

iii. Self-Concept and Self-Esteem Factors influencing self concept: Cognitive development Peer relationships Physique according to age Degree of attractiveness Career (and other) goals and ability to achieve these Problem solving ability iv. Self-Actualization Achievement of career goals Development of problems-solving ability v. Socio-Economic The effects of beliefs and customs on health 4. Environmental i. Home Appropriate housing and living conditions Noise Lighting Ventilation

Temperature Safety Sanitation

Vector control Food and milk Methods of communication Newspaper Telephone

Hygiene Water availability and safety Other

Radio Television

ii. Community General sanitary measures or community Cleanliness of streets Disposal of sewage and solid wastes Management of pollution Cleanliness of public places, e.g., restaurants, etc. 5. Lifestyle Developing appropriate health habits Work habits Leisure time activities Use of substances, e.g. alcohol, drugs, tobacco etc. Developing hobbies

6. Community Resources Availability of resources to promote and maintain health XXII. Application of the Nursing Process to Individuals with Needs Interferences Along the Life Cycle caused by Bio-Pyschsocial Factors as Follows: Example I Example II Example III Example IV Example V Example VII Gastro-enteritis Age 1 years Learning Disabilities Age 10 years Pregnancy Age 13 years Hysterectomy (Fibromyoma of Uterus) Age 39 years Diabetes Mellitus Age 55 years Senility Age 80+ years

EXAMPLE I FACTOR: GASTRO ENTERITIS (1 YEARS) A. Assessing 1. Physiological i. Oxygen Color Breathing patterns Vital signs Cough ii. Nutrition Nutritional status (growth chart) Hydration Diet iii. Elimination Frequency, consistency, quantity, color of: Vomitus Stools Urine iv. Sexuality Psychosexual development v. Activity, Rest and Comfort Degree of restlessness or lethargy vi. Sensory Stimulation vii. Safety and Security Integrity of skin Mucous membranes 2. Psychosocial

i. ii. iii. iv.

Love and Belonging Trust Self-Esteem Self-Actualization Effects of illness and hospitalization on child and family Parent/child relationships Position of child in the family v. Socio-Economics Familys belief about illness vi. Economics Family finances 3. Environmental Ecology Housing and living conditions Sanitation Vectors Water Food and milk hygiene Lifestyle Family life patterns and effects on child

4.

B. Planning 1. 2. 3. 4. 5. Nursing diagnoses Problem list actual and potential problems Critical areas of care and expected outcomes Required resources Team approach

C. Implementing 1. Physiological i. Oxygen - Check color - Monitor vital signs - Ensure clear airway - Administer oxygen Nutrition

ii.

iii. iv. v.

Analyze results of growth chart Rehydrate Provide adequate diet Monitor weight for age

Elimination - Monitor and record intake and output Activity and Rest - Ensure bed rest Sensory Stimulation - Provide play opportunities - Provide visual and tactile stimulation Sexuality Observe level of psychosocial development Safety and Security - Interpret diagnostic tests - Administer prescribes medications - Give personal hygiene care - Prevent cross infection - Protest from accidents and trauma

vi. vi

2. Psychosocial Foster relationships between: Parent/child Nurses/child and family Child/child Significant others 3. Environmental Foster environmental hygiene 4. Lifestyle Advise on changes/modifications in familys lifestyle if necessary 5. Health Teaching/Counselling to Family on: Teach/counsel family about gastro-enteritis in relation to: o Condition of gastro-enteritis o Causes o Prevention o Management o Coping skills

o Availability of resources o Follow-up o Family budgeting 6. Community Resources Referrals Coordination and continuity of care Follow-up D. Evaluating 1. Achievement of expected outcomes 2. Alleviation of problems

EXAMPLE II FACTOR: LEARNING DISABILITIES (10 YEARS) A. Assessing 1. Physiological i. Oxygen Color Vital signs ii. Nutrition Nutritional status (growth chart) Diet Weight Height Types of foods eaten and their additives iii. Elimination Bowel patterns Bed wetting iv. Sexuality Peer group relationships Sibling relationships v. Activity and Rest and comfort Attention span Degree of activity

o Restlessness o Listlessness Sleep patterns and disturbances Involvement in sports Physical deportment and motor coordination Aggression

vi. Sensory Stimulation Visual acuity Hearing ability Language development Speech pattern Sensorium vii. Safety and Security Self-care ability Immunization record Skin integrity Diagnostic tests 2. Psychosocial i. Love and Belonging Family unit o Dynamics ii. Trust Relationships of child to: Parents Siblings Teachers Peers Significant others Self-Concept Self-Esteem Self-Actualization Achievement of developmental tasks Industry

iii. iv. v.

 vi.

Ambivalence Independence Child-rearing practices Education/school system Parental expectations Expectations of the school; system Familys cultural beliefs and customs Family budget

Soci-Cultural

vii.

Economics

3. Environmental Housing Living conditions Overcrowding Basic sanitation Vectors Stimulation in the home Supervision in the home Water and food hygiene

4. Lifestyle

Familys lifestyle: Religious practices Eating, drinking patterns Ability to cop with problems Dress patterns of family and child Family spacing Recreational activities

B. Planning 1. 2. 3. 4. 5. Nursing diagnoses Problem list actual and potential problems Critical areas of care and expected outcomes Required resources Team approach

C. Implementing 1. Physiological i. Oxygen

ii. Nutrition Advise on diet for age Advise on preparation and eating of nutritious meals Monitor weight and height iii. Elimination - Encourage child to develop good bowel and urinary habits iv. Sexuality - Monitor levels of psychosexual development v. Activity, Rest and Comfort - Establish prescribed daily routine for child if necessary - Promote involvement in school activities - Implement prescribed therapy vi. Sensory Stimulation Encourage use of protheses for visual and/or hearing defects Ensure speech therapy Develop with teachers family, child and others, programmes for specific learning disabilities vii. Safety and Security Administer prescribed medications Teach accident prevention Teach personal hygiene Teach potential dangers of drugs, alcohol, tobacco and other substances 2. Psychosocial i. Love and Belonging - help family to accept childs disability - encourage sharing relationships in family if necessary - encourage family involvement in childs school achievement Trust foster positive relationships between: - parents/child - siblings/child - teachers/child - peers/child - significant others Self-Concept

ii.

iii.

iv.

assist child to recognize and accept his strengths and weakness

Self-Esteem - assist child to understand and accept his disability

v. Self-Actualization - establish goals achievable by child - facilitate goal achievement - reinforce successes - encourage familys recognition and acceptance of childs level of achievement - implement behaviour modification programmes if necessary vi. Family Economics - assist family with budget preparation, refer to social agencies if necessary 3. Environmental - counsel family - sanitation of home including vector control - basic living and housing conditions - problems of overcrowding - structured and stimulating home environment - refer if necessary to social agencies regarding housing and living conditions 4. Lifestyle - encourage family spacing if necessary - counsel on familys lifestyle - encourage hobbies within childs capabilities, familys preferences and resources 5. Health Teaching/Counselling - childs relationships with others - expected level of achievement within childs capabilities - nutrition - immunization - importance of family support and involvement in childs education - measures to reinforce childs achievements - methods of establishing achievable goals with child, teachers and others - importance of continuity of prescribed programmes

techniques of developing parent-support groups in the community genetic counseling assist family to develop appropriate coping skills

6. Community Resources - provide information on community resources - referral to school psychologist, social worker, etc., if necessary follow-up D. Evaluating 1. Achievement of expected outcomes 2. Alleviation of problems.

EXAMPLE III FACTOR: PREGNANCY (13 YEARS) A. Assessing 1. Physiological i. Oxygen ii. respiration vital signs

Nutrition - dietary habits - types of food - idiosyncrasies - weight, height - morning sickness, nausea, vomiting Elimination - diaphoresis - frequency, dysuria, output - bowel habits Sexuality - menstrual history - breast changes - sexual intercourse - vaginal discharge - enlarged uterus - knowledge of health and family life education - male/female relationships

iii.

iv.

Activity, Rest and Comfort - exercise patterns and tolerance - rest periods - sleep patterns vi. Sensory Stimulation visual acuity hearing ability speech pattern 3. Environmental - adequate housing and living conditions - need for privacy 4. Lifestyle - smoking - substances abuse family life patterns and effects hobbies B. Planning 1. 2. 3. 4. 5. Nursing diagnoses Problem list actual and potential problems Critical areas of care and expected outcomes Required resources Team Approach Actual Problems Psychosocial Family conflicts Emotional problems Economic needs Housing/shelter Physical Low haemoglobin inadequate diet constipation frequency of micturition Potential Problems Psychosocial Withdrawal Tearfulness Aggressiveness Physical elevated blood pressure proteinuria headache

v.

Anxiety Rejection

hemorrhage abortion Insomnia Oedema Weight gain: excessive None

C. Implementing 1. Physiological i. Oxygen monitor rate and depth of respiration monitor degree of dyspnoea on exertion and at rest monitor vital signs including foetal heart rate teach breathing exercises for labor

ii. Nutrition - advise dietary measures t correct iron deficiency anemia - monitor weight gain - monitor dental health, refer to dentist iii. Elimination - test urine - advise on dietary management of constipation - check for odema/fluid retention iv. Sexuality - counsel regarding sexual practices - assist, under supervision of midwife, with monitoring foetal growth - physical assessment of client v. Activity, rest and Comfort - encourage physical activity, exercise and rest periods - suggest activities to promote sleep vi. Sensory Stimulation - encourage diversional activities (e.g. games. Films, music) vii. Safety and Security - advise on personal hygiene

interpret diagnostic tests explain prescribed medications advise regarding vulval hygiene

2. Psychosocial i. Love and Belonging ii. Trust - encourage family acceptance of pregnancy - encourage other social relationships iii. Self-Concept iv. Self-Esteem - encourage adolescent to accept pregnancy - encourage adolescent to participate in, and accept responsibility for, care during and after pregnancy - provide for privacy 3. Environmental - foster environmental sanitation - control environmental hazards 4. Lifestyle modify as necessary develop and foster hobbies encourage plans to continue education

5. Health Teaching/Counselling - pregnancy and birth process - family life education - family budget - resolution of conflicts - family communication - sexuality - care of baby - preparation for parenthood - nutrition - exercise - care of breasts 6. Community Resources - refer to social agencies - provide for financial assistance - refer to maternity clinic - coordination and continuity of care - follow-up D. Evaluating

1. Achievement of expected outcomes 2. Alleviation of problems

EXAMPLE IV FACTOR: HYSTERECTOMY (FIBROMYOMA OF UTERUS) (39 YEARS) A. Assessing 1. Physiological i. Oxygen vital signs pallor

ii. Nutrition nutritional status weight dental health appetite hydration

iii. Elimination - urinary output - dysuria - frequency of micturition - bowel habits iv. Sexuality - abnormal vaginal bleeding - obstetrical history - sexual history - family planning practices - abdominal enlargement - loss of fertility v. Activity, Rest and Comfort - exercise pattern - sleep pattern and disturbances

vi. Sensory Stimulation - visual acuity and prosthesis - hearing ability and prosthesis vii. Safety and Security - personal hygiene - skin integrity - pre-anesthetic and pre-operative readiness \ 2. Psychosocial i. Love and Belonging ii. Trust - wife/husband relationship - family relationships iii. Self-Concept - knowledge of condition, required surgery and implications iv. Self-Esteem - body image v. Self-Actualization - job satisfaction - community involvement vi. Socio-Cultural - husband and family knowledge of the condition and implications of the intervention Economic - family finances - health and hospitalization insurances 3. Environmental - housing and living conditions - basic sanitation 4. Lifestyle substances abuse occupation hobbies vii.

B. Planning 1. Nursing diagnoses 2. Problem list actual and potential problems 3. Critical areas of care and expected outcomes 4. Required resources 5. Team approach

C. Implementing 1. Physiological i. Oxygen ii. Nutrition iii. maintain adequate nutrition: diet intravenous infusion monitor vital signs ensure clear airway assist with breathing exercises administer blood transfusion as ordered

Elimination - maintain and record intake and output - monitor urinary drainage - give catheter care - ensure bowel activity Activity, Rest and Comfort - positioning - ensure bed rest as prescribed - provide exercise - ambulate early - promote self-care activities v. Sensory Stimulation - Create stimulating environment - Reduce painful stimuli vi. Sexuality counsel wife and husband on implication of loss of uterus observe for changing moods and needs

iv.

vii. Safety and Security - maintain personal hygiene - administer prescribed medications - give routine or special pre- and post-operative care - interpret laboratory values - observe for allergic reactions - observe for, and prevent complications - prepare for discharge 2. Psychosocial i. ii. Love and Belonging Trust iii. iv. v. Self-Concept Self-Esteem Self-Actualization - provide for occupational therapy - encourage self-care Socio-Cultural Family Economics - provide for completion of insurance forms encourage acceptance of condition encourage family participation in care

vi. vii.

3. Environmental 4. Lifestyle -

modify living conditions modify as necessary

5. Health Teaching/Counselling - give instructions for discharge - do anticipatory teaching: menopause sexual function activities

6. Community Resources - arrange for referrals - coordination and continuity of care - follow-up D. Evaluating Achievement of expected outcomes Alleviation of problems EXAMPLE V FACTOR: HYPERACTIVE BEHAVIOUR (ANXIETY NEUROSES) (35 YEARS) A. Assessing 1. i. Physiological Oxygen - vital signs - breathing pattern - pulse rate ii. Nutrition - appetite - food fads - idiosyncrasies - pica - weight iii. Elimination - bowel patter frequency - voiding pattern frequency - diaphoresis iv. Sexuality - sexual pattern and practice - body image - role identity v. Activity, Rest and Comfort - rest patterns - degree of activity and agitation - gait and posture - hand movements, facial expressions - sleep patterns and disturbances 1. 2.

vi. Sensory Stimulation - environmental stimuli - irritability/hostility - sensorium - visual, auditory, memory distortions - speech patterns - phobia - decision-making ability, reasoning and comprehension vii. Safety and Security - personal hygiene practices - mode of dress - nail biting 2. Psychosocial i. Love and Belonging ii. Trust - family history - recent changes, loss/grief, separation - family dynamics/relationships - spousal relationships - child/parent relationships - in-law relationships - sibling relationships - significant others relationships - peer group/work relationships - acceptance of others (e.g., minority groups) iii. Self-Concept iv. Self-Esteem - self-acceptance - ambivalence self and others - mood swings - self-reliance, self sufficiency - guilt, doubts, fears, obsessions - acceptance by others - usual coping patterns - problems with law enforcement officers v. Self-Actualization - social and community development - lifes goals/philosophy - religious and political concerns

3. Environmental ecology residence facilities o housing o lighting o water o sanitation o companionship relation with social/ethnic groups customs values beliefs income/income source s[ending pattern use of patent medicines substance abuse occupation and job changes leisure/recreational activities

4. Lifestyle B. Planning 1. 2. 3. 4. 5. Nursing diagnoses Problem list actual and potential problems Critical areas of care and expected outcomes Required resources Team approach

C. Implementing 1. Physiological i. Oxygen - monitor vital signs ii. Nutrition - encourage food intake - offer small, attractive meals - monitor weight gain iii. Elimination - encourage regular bowel activity

monitor urinary output

iv. Sexuality - monitor interest in appearance v. Activity, Rest and Comfort - establish controlled activity programme - promote suitable and safe sleep environment - give prescribed medications - note effects of drug therapy vi. Sensory Stimulation - control environmental stimuli - maintain calm attitude and manner - give firm, clear instructions vii. Safety and Security - ensure good personal hygiene - establish a team approach to care 2. Psychosocial i. Love and Belonging - establish helping nurse/patient relationships - therapeutic communication; process recording - observe response to therapy ii. Trust encourage development of trust encourage acceptance of behaviour adopt non-judgmental attitude document and report all observations

iii. Self-Concept iv. Self-Esteem - assist client to face realities - support improvement in self-confidence v. Self-Actualization - develop therapeutic milieu - encourage occupational and group therapy - encourage diversional therapy games, music, etc., - provide behaviour therapy - provide psychotherapy - support employment efforts

vi. Family Therapy - establish positive relationships - allow for verbalization of feelings - encourage - participation: - understanding of problem - use of coping mechanisms - cooperation with therapists 3. Environmental 4. 5. modify environment where necessary refer to social services

Lifestyle associations - modify to ensure meaningful Health Teaching/Counselling educate patient and family in relation to: acceptance of patients behaviour use of discharge medications recreational activities work activities signs of relapse personal hygiene nutrition setting limits on patients behaviour creating a therapeutic environment follow-up and continuity of care through use of team approach

6.

Community Resources - referral services - coordination and continuity of care - follow-up Evaluating 1. Achievement of expected outcomes 2. Alleviation of problems EXAMPLE VI FACTOR: DIABETES MELLITUS (55 YEARS) A. Assessing 1. Biographic Data

D.

2. Physiological i. Oxygen -

family history

peripheral circulation vital signs

ii. Nutrition - weight - fluid intake - appetite - dietary practices - hydration - dental health iii. Elimination - glycosuria - voiding pattern - urine volume - bowel habits - attraction of ants to urine iv. Activity, Rest and Comfort - gait - exercise tolerance - sleep patterns v. Sensory Stimulation - sensorium - visual acuity - tactile sensation vi. Sexuality - pruritis - sexual activities - body image vii. Safety and Security - blood sugar levels - condition of skin

3.

Psychosocial i. ii. iii. Self-Concept Self-Esteem - body image

4.

Love and Belonging - family relationships iv. Self-Actualization v. Family Income Environmental - occupational hazards - housing and living conditions - hazards in the environment Lifestyle smoking habits substance abuse sporting and recreational activities occupation

5.

B.

Planning 1. Nursing diagnoses 2. Problem list actual and potential problems 3. Critical areas of care and expected outcomes 4. Required resources 5. Team approach Implementing 1. Physiological i. Oxygen monitor vital signs monitor peripheral circulation

C.

ii. Nutrition - advise on: - dietary management - food exchanges - required calories - meal distribution

iii. Elimination - urinalysis - monitor urine volume iv. Activity, Rest and Comfort - advise on activity programmes v. Sensory Stimulation - manipulate environment vi. Sexuality - advise on genital hygiene vii. Safety and Security - Interpret diagnostic tests - Counsel on: drug therapy General hygiene Special care to feet, eyes, skin and nails Special care if surgery is warranted 2. Psychosocial i. Love and Belonging ii. Trust iii. Self-Concept iv. Self-Esteem - encourage family participation in care - encourage involvement in community affairs - suggest types of diversional therapies - suggest sources for financial assistance if necessary v. Self-Actualization 3. Environmental - control environmental hazards 4. Lifestyle - modify lifestyle as necessary - develop new recreational interests - limit drug, alcohol and tobacco consumption 5. Health Teaching/Counselling - condition and complications - management to foster self-care and self-reliance - urine testing - dietary therapy

drug therapy care of feet, eyes, nails and skin exercise sexuality prevention of infection importance of follow-up travel eating out blood sugar monitoring

D.

6. Community Resources (e.g., Diabetic Clinics and Associations) - referral services - coordination and continuity of care - follow-up Evaluating 1. Achievement of expected outcomes 2. Alleviation of problems EXAMPLE VII FACTOR: SENILITY (80+ YEARS)

A.

Assessing 1. Physiological i. Oxygen - breathing patters - vital sogns - history of cardiovascular and respiratory problems - cough - sputum - peripheral ii. Nutrition - condition of teeth - dental health - diet - food preferences - fluid intake and preferences - weight - swallowing

iii. Elimination - bowel pattern - voiding pattern - continence - perspiration iv. Sexuality - sexual need v. Activity, Rest and Comfort - posture - sleep pattern - exercise - recreation - mobility vi. Sensory Stimulation - mental status - visual acuity and prosthesis - hearing ability and prosthesis - speech pattern - sensorium vii. Safety and Security - use of prosthesis and their conditions - personal hygiene - prescribed medications - hazards in environment 2. Psychosocial i. Love and Belonging ii. Trust - family support - significant others support - interaction with family and others iii. Self-Concept iv. Self-Esteem v. Self-Actualization - ability for self-care - acceptance of readiness for death

vi. Cultural Belief About Aging vii. Economic Situation - finances 3. Environmental - housing and living conditions - environmental hazards - basic sanitation 4. Lifestyle B. Planning 1. 2. 3. 4. 5. Nursing diagnoses Problem list actual and potential problems Critical areas of care and expected outcomes Required resources Team approach concept of disengagement recreation hobbies occupational activities participation in community activities

C. Implementing 1. Physiological i. Oxygen - monitor effects of activity on cardiovascular and pulmonary systems ii. Nutrition - advise on good dental health - ensure provision and eating of nutritious foods - stimulate appetite by various measures iii. Elimination - ensure bowel regularity - measures to cope with incontinence iv. Sexuality - encourage peer association - encourage hair and nail care and attractive dressing Activity, Rest and Comfort

v.

vi

encourage exercise daily walks provide for recreational activities ensure adequate rest

Sensory Stimulation - reality reorientation - assist with provision of prosthesis - assist with development of stimulating environment

vii. Safety and Security - protect from environmental hazards - counsel on personal hygiene - administer and/or advise on medications - check prostheses for safety - advise on appropriate uses and care of respective prostheses - ensure appropriate management of diagnosed ailments 2. Psychosocial i. ii. iii. iv. v. Love and Belonging Trust Self-Concept Self-Esteem Self-Actualization - involve client in planning activities - counsel on preparation for death vi. Socio-Cultural - monitor effects of cultural beliefs about aging on clients welfare vii. Economics - ensure financial assistance and legal aid 3. Environmental - ensure safe environment - create a home-like environment 4. Lifestyle develop new hobbies/activities

5. Health Teaching/Counselling - nutrition - hygiene - dental health - activity/exercise - accident prevention - leisure time - maintenance of independence - sexuality - economic situation 6. Community Resource - referral services - coordination and continuity of care - follow-up D. Evaluating 1. Achievement of expected outcomes 2. Alleviation of problems

GUIDELINES FOE DEVELOPING THE TABLE OF SPECIFICATIONS While it is recognized that the candidate may utilize all levels of the cognitive taxonomy in solving nursing problems, the objective-type items will focus on testing the knowledge, comprehension and application skills of the candidate. On the other hand, the essay-type items will test all levels of the cognitive and affective taxonomies, but in these terms emphasis will be placed on application, analysis, synthesis and evaluation skills of the candidate. Weighting of Papers The four papers composing the examination will be weighted as follows: Clinical Nursing Functional Nursing 60-70 percent 30-40 percent

The above weightings define the parameters and standards for the professional nurse examination at the beginning level of practice. Weighting of the Total Examination Final weighting of each section of the Regional Examination will be at the dissection of the RGNCs, to be decided on at each annual meeting. However, the suggested weightings are: Objective-type items 60% Essay-type items 40% It is further suggested that the essay-type items be weighted no higher than 50% of the total examination. Scoring

The pass mark for each paper will be set at 60 percent. The Regional Examination will define, for each examination paper, a minimum score below a nurses practice is at risk. Each Member Country, however, will reserve the right to decide on the registration criteria based on its GNC Regulations. The examinations will also produce for each candidate a set of scores to describe hi/her performance.

Weighting of Components of the Blueprint The following weightings for various components of the Blueprint document will be used: 1. Types and Levels of Nursing Skills Cognitive Objective Items Knowledge Comprehension Application Analysis Synthesis Evaluation Affective and Psychomotor Both the affective and psychomotor domains will be reflected in the written examination. Essay-type questions will test at all levels of the affective domain. Only the cognitive component of the psychomotor domain will be tested in the written examination. Guidelines for clinical assessment relative to the psychomotor domain are provided in the Blueprint. 2. Major Concepts of the Blueprint Nursing Competencies Clinical Nursing The Nursing Process: 25 ) 35 ) 40 ) 100% 25) 35) 20) 20) 100% Essay Items

 Functional Nursing:

Assessing Planning Implementing Evaluating

30% 25% 25% 20% 30% 30% 10% 30%

The Profession of Nursing Administration/management Research Teaching, Interviewing and Counselling 2.2 Categories of Health Problems

All categories of health problems will be tested in each examination. The emphasis placed on a category will related to the prevalence of health problems for that category in the Caribbean. Major emphasis will be placed on the following categories: Infectious/inflammatory Neoplastic Accident/trauma Degenerative Psychosocial/psychiatric Environmental

Less emphasis will be placed on these categories: Congenital Genetic Infestations Allergic/immunological

A minimum number of items will test the candidates knowledge and understanding of the health infrastructure of the Region In preparing essay-type items, the writer will include aspects of primary, secondary and tertiary levels of health. As well as primary, secondary and tertiary levels of health care. 2.3 Growth and Development

Each age group will receive equal weighting since it is necessary for a professional nurse to be acknowledgeable in all areas. Needs The examination will deal with all the needs, since they are common to individuals at all stages of the life cycle. 3. The examination will deal with all areas of Nursing as outlined below: 3.1 Clinical Nursing Content Health Growth and Development Needs and their Satisfaction Factors Affecting Needs Satisfaction Needs Alterations Indicators of Community Health High-risk Individuals and Groups, including Emergencies High Programmes for Special Groups Health and Family Life Education Family Unit Pregnancy

3.2 Functional Nursing Content Role of the Nurse in Disaster Preparedness and Management Group Dynamics Teaching and Learning Process Communication Process Profession of Nursing Health and Health-Related Organizations and Agencies at National, Regional and international Levels Administration/management Application of Basic Research Methodology in Solving health Problems Under Functional Nursing, the most emphasis will be placed on the Profession of Nursing and Administration/Management. Man and His Environment

The content related to Man and His Environment will be integrated into the nursing content. However, no more than 30 percent of all the items will reflect the content of man and His Environment.

TEST ITEMS Pre-Testing of Items All items to be used for Regional Examination will be pre-tested. Lifespan of Objectives and Test Items 1. Specific objectives will be retained for five (5) years, reviewed and updated as necessary. 2. Test Items will be used for one examination, stored, review and made available for reuse after two years. 3. Examination papers (scripts) will be retained by each GNC for five (5) years and then destroyed.

TABLE 1 COMMON HEALTH PROBLEMS IN THE CARIBBEAN ARRANGED BY AGE GROUPS AND CATEGORIES CATEGORIES AGE GROUPS Birth - 4 years Congenital/Genetic Intussucpeption Syphilis neonatal jaundice cleft lip Oesophageal atresia
malformatos of reproductive organs and related structures

AGE GROUPS 5 - 11 years 12 - 19 years 20 - 44 years 45 -64 years 65+ years

scolosis haemophilia

pyloric stenosis Hurschsprungs imperforate anus Talipes hydrocephalus spina bilula heart conditions

CATEGORIES
Birth - 4 years Congenital /Genetic (cont=d) Meningoceole Cataract Downs syndrome 5 - 11 years

AGE GROUPS
12 - 19 years 20 - 44 years 45 - 64 years 65+ years

Sickle cell anemia genito-urinary malformations

physical disabilities Infectious/ Inflammatory umblical infections eye infections upper respiratory tract infections broncho pneumonia bronchiolitis diarrheal diseases tetanus HIV+ skin disorders communicable diseases dental health

rheumatic fever Meningitis Osteomyelitis acute glomerulonephritis

CATEGORIES CATEGORIES

AGE GROUP AGE GROUPS Birth - 4 years cot deaths eczema child abuse burns fracture poisoning head injuries foreign bodies internal injuries dismemberment wounds asphyxiation 5 - 11 years- 11 years 12 -12 -years 19 19 years 5 Nephritic syndrome hay fever Anaphylactic shock serum sickness abortion ectopic gestation 20 20 - 44 years - 44 years 45 - 64 years 65+ years 45 - 64 years 65+ years

Accidents/Trauma Allergic/ Immunological (cont=d)

Infestations

helminal tests scabies schistos masis filariasis malaria pediculosis dengue

sexually transmitted diseases multiple injuries urinary tract due to motor infections vehicles pelvic inflammatory disease appendicitis pulmonary tuberculosis

Systemic lupus erythematous Rheumatoid arthritis polyarthritis industrial polyarteritus accidents nodosa prelapsed intravertebral disc

AGE GROUP CATEGORIES CATEGORIES Neoplastic (cont=d) Infectious/ Inflamattory (cont=d) Birth - 4 years Birth - 4 years 5 - 11 years 12 - 19 years 20 - 44 years AGE GROUP 20 - 44 years prostatitis viral hepatitis cholecystitis leptospirosis bacterial endocarditis Hansens disease pancreatitis bronchitis urethral stricture hernias Wilms tumour leukemia visual defects neuroblastomia brain hearing defects tumrours smooth muscle bone tumours tumours fibroadenoma ovarian cysts ovarian tumours 45 - 64 years 45 -64 years polycythemia vera Periodontal benign prostatic disease hyprotrophy cancer of: penis tongue lungs colon larynx and oesophagus prostate 65+ years 65+ years senile vaginitis

5 - 11 years

12 - 19 years

Degenerative Neoplastic

transient ischaemia hypertension peptic ulcer myocardial infraction renal uterine cancer calculi breast cancer varicosities fibroids aneurysms cancer of the emphysema stomach

urinary incontience osteo-arthritis parkinsons disease

CATEGORIES Birth - 4 years Degenerative (cont=d) 5 - 11 years 12 - 19 years

AGE GROUP 20 - 44 years 45 - 64 years cirrhosis of the liver arteriosclerosis glaucoma cataract cerebrovascular disease congestive cardiac failure osteoporosis protein calorie malnutrition failure to thrive inborn error of metabolism anaemias vitamin deficiencies malabsorption syndrome 65+ years

Metabolic/ Nutritional/ Endocrine

non toxic goitre gout, obesity thyrotoxicosis myxoedema diabetes mellitus

CATEGORIES Birth - 4 years Environmental ecological imbalance vectors unsafe housing overcrowing poor sewage and solid waste disposal poor water management improper food and milk hygiene disaster: manmade and natural deficient educational opportunities breakdown in social order 5 - 11 years

AGE GROUP 12 - 19 years 20 - 44 years 45 - 64 years 65+ years

Health infrastructure

types and availability of services and human resources

ANNEX II

TABLE II CORE LIST OF NURSING SKILLS FOR SCHOOL-BASED ASSESSMENT CLINICAL NURSING Oxygen 1. 2. 3. 4. 5. 6. Take, record and interpret vital signs Administer oxygen by mask, nasal canula or tent Administer steam inhalation Suction patient Perform coughing and deep breathing exercises Collect specimens $ sputum $ nasal swab $ throat swab COGNITIVE PSYCHO MOTOR AFFECTIVE

7.

Perform cardiopulmonary resuscitation

8.

Prepare patient for and manage during and after: $ $ $ $ $ thoracentesis bone marrow aspiration tracheostomony underwater seal drainage nebulization

Nutrition 9. 10. Prepare and administer oral and parenteral fluids Serve meals $ regular $ special diets 11. 12. 13. Feed helpless patients Feed infants and preschoolers Administer artificial feeding: $ intravenous $ nasogastric $ gastrostomy $ hyperalimentation 14. 15. Measure height and weight Measure and record intake and output

Elimination 16. 17. 18. 19. 20. 21. 22. Prepare for urethral catherization (male) Prepare for urethral catherization (female) Collect urine specimens from patient to include 24-hour specimen Perform urinalysis Give and remove bed pans/urinals Care for and remove indwelling catheters Manage urinary bladder drainage $ $ $ $ 23. 24. 25. 26. supra-pubic catheter indwelling uretheral catheter condom drainage other

Irrigate urinary bladder Give cleansing enema Insert rectal suppositories Care for stoma

Activity, Rest and Comfort 27. 28. 29. 30. 31. 32. Observe neurological signs Care for patient in splints, casts and tractions Perform range-of-motion exercises Assist patient to move in and out of bed Lift, turn and position patient Perform last offices

Sensory Stimulation 33. 34. 35. 36. 37. 38. 39. Instill drops - eye, ear and nose Assess ocular and auditory senses Cleanse eyelids Collect conjunctival swabs Apply eye-pads Irrigate eye Irrigate ear

Safety and Security 40. Administer medications: $ $ $ $ 41. 42. oral intradermal hypodermic intramuscular

Store drugs Care for wound: $ surgical dressing $ removal of sutures and clips $ removal of drain packs $ wound irrigation Give bed bath Give mouth care Give skin and pressure care Apply bandages, splints, restraints, tourniquets, other Use and maintain prostheses: $ wheelchair $ walkers $ canes $ crutches $ artificial limbs $ other

43. 44. 45. 46. 47.

Safety and Security (cont=d) 48.

49. 50. 51. 52. 53. 54. 55. 56. 57. 58. Apply electric and electronic patient devices Conduct a screening programme Make beds and use bed accessories Arrange equipment/instruments for minor operations Perform barrier nursing and infection control Do case finding and contact tracing Counsel patient and family Prepare patient/client and equipment for delivery Observe ante, intra and post partum patients Give sitz bath, vulval swab, episiotomy care Prepare patient for: $ $ $ $ $ surgery bone marrow aspiration paracentesis abdominis lumbar puncture endoscopy

Sexuality
59. Prepare for examination of genital areas for (male and female) Nursing Process 60. Utilize the nursing process in giving care:

assessing to include history taking and completephysical assessment planning to include written care plan implementing to include report and recording evaluating to assess outcomes of care
FUNCTIONAL NURSING 61. 62. Use interview techniques Counsel and teach patient/client

63. Perform management skills $ planning $ organizing $ directing 64. Apply: $ epidemiological approach $ research methodology

ANNEX III

GUIDELINES FOR THE USE OF CORE LIST OF NURSING SKILLS

FOR ASSESSMENT OF CANDIDATES

Guidelines
1. Continuous clinical assessment of students should be done by nursing schools throughout the educational programme, using the approved core list of nursing skills. 2. All skills outlined in the core list must be taught. 3. All items included in the core list must be completed successfully before entry to the final programme examination. 4. Close supervision and teaching of students in the clinical areas must be provided. 5. Students must be made aware of their strengths and weaknesses through the use of anecdotal records. 6. Before the final programme examination, students must complete a specified number of hours of practical instructions as determined by the General Nursing Council. 7. A standardized checklist will be used to determine the students proficiency in each area of skill. 8. The students performance of each skill must be assessed and recorded on the checklist by the person supervising the student. 9. Activities should be grouped according to patients needs. 10. The critical skills indicated by asterisks as outlined in the checklist denote that some steps of the nursing procedures are critical and can endanger the life of a patient if performed inaccurately. 11. Any student who fails in performing accurately a skill(s) which is/are indicated as critical will, at the discretion of the examiners, be asked to discontinue the assessment. 12. Students should be given further instruction for a specified period before reassessment of those skills, which were not performed accurately.

N.B.

Examples I and II provide an assessment checklist for surgical aseptic technique and an observation checklist, respectively.

ANNEX III
EXAMPLE I ASSESSMENT CHECKLIST FOR SURGICAL ASEPTIC TECHNIQUE Candidate No: Candidates are expected to perform in all areas list and MUST pass in areas with as asterisk (*) Examiners: ____________________________________ ____________________________________ ____________________________________

AREAS OF ASSESSMENT

PASS

FAIL

REMARKS

SIGNATURE

*1. 2. *3. *4. *5. 6. *7. 8. 9.

Preparation and care of equipment and environment Communication with the patient Maintenance of patients privacy Maintenance of sterile field Manual dexterity in use of equipment Comfort of patient Knowledge of underlying principles Disposal of infected dressing Recording and reporting of relevant Information

ANNEX III EXAMPLE II OBSERVATION CHECKLIST PROCEDURE: CANIDATE NO.: COUNTRY:

OBSERVER: PROCEDURAL STEPS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. TOTAL COMPLETED PARTIALLY COMPLETED NOT COMPLETED CREDIT REMARKS

ANNEX IV

CRITERIA FOR CLINICAL ASSESSMENT

1. 2. 3. Nursing theory and clinical practice must be integrated. Students must be taught nursing courses relevant to procedures. Clinical objectives related to nursing courses must be developed to guide students practice; must be discussed with students and their supervisors; and must be used by the school, nursing service and students. Tools for clinical evaluation, derived from the clinical objectives, must be developed and used to assess students performance in the clinical areas. Tools for clinical evaluation include checklists, anecdotal records, profiles, other. Checklists of nursing procedures must be developed in a sequential format. Appropriate supervision, continuous assessment and feedback to the students in the clinical areas are required to improve clinical performance. In order to complete the clinical component of the nursing programme, the students must be assigned to all designated areas for the specified time. Students must be allowed to practice in the Demonstration Room/Practical Room to gain mastery of skills. Clinical assignment and evaluation tools must form part of the students permanent records. Clinical assessment must focus on the overall care provided to one or more patients, using the nursing process and will include the related procedures performed. Clinical assessment will include assessment of the overall organization and management ability of students, to include such areas as management of time and resources, communication skills, etc.

4. 5. 6. 7. 8. 9. 10. 11. 12.

ANNEX VII GLOSSARY For the purpose of this Blueprint, the following terms are operationally defined: 1. Comprehensive nursing care Promotive, preventitive, restorative/curative, habilitative/rehabilitative care. 2. Critical elements of needs interferences The actual and/or potential responses to need interferences that threaten the physiological and psychosocial well-being of the individual, family and community. 3. Critical areas of care Comprehensive nursing care provided in response to the critical elements of needs interferences. 4. Disabled A person with structural and/or functional defects who is able to carry out activities of daily living within his capacity. 5. Elderly The term elderly in the Blueprint refers to individuals age 65 and over, and is used synonymously with the term aging. 6. Factor Conditions that maintain or change the health status of man. For the purpose of the Blueprint, the following four factors are identified: o o o o Biological Psychosocial Environmental Lifestyle innate physiological factors mental and interpersonal factors physical factors external to man typical patterns of living

Maternity Cycle That period from conception to six weeks post-natal. Any reference to the maternity cycle includes care of the mother, neonate and other members of the family.

Optimum health The highest level of health achievable by the individual.

ANNEX VIII BIBLIOGRAPHY

1. 2. 3. Bloom, Benjamin, S. (1965). Taxonomy of educational objectives: cognitive domain. New York: David McKay Co. Inc. Canadian Nurses Association. (1977). A Blueprint for a Comprehensive Examination for nurses registration/licensure. Ottawa: CNATS Caribbean Community Secretariat. (1979). Report of workshop on phase II of feasibility study on regional examination for nurse registration. (Unpublished) Guyana: CARICOM Secretariat Caribbean Examinations Council. (1977) Secondary Education certificate: Mathematics syllabus. Barbados: CXC. Caribbean Schools of Nursing. (1976). Curricula, Ministries of Health and PAHO/WHO. (Unpublished) Krathwohl, David, r., bloom, Benjamin, Masta, S., and Bertran, B. (1964). Taxonomy of educational objectives: affective domain. New York: David McKay Co., Lukmann, Joan and Sorensen, Karen. (1980). Medical-Surgical nursing: a Psycho-physiological approach. Philadelphia: W.B.Saunders Co. Reillky, Dorothy E. (1975). Behavioral Objectives in nursing: evaluation of Learner attainment. New York: Appleton Century-Crofts.

4. 5. 6. Inc. 7. 8.