Community Nursing Standards and Performance Criteria

SECTION 6: COMMUNITY AREAS WHERE STUDENT NURSE UNDERTAKE COMMUNITY

Standard- 1 PERFORMANC E STANDARDS VERIFICATION CRITERIA Means of verification 1. The nursing student is able to perform basic Community procedures in Community Area Check Procedure log book Determine by observing or interviewing two students whether the student following steps/tasks: Competency tracking record *Bag Technique *Measuring Vital Signs *Urine Analysis * Hb Estimation *Ante natal Care *Post natal Care *New-born Assessment *Anthropometric Examination Score Standard-1

Standard- 2 PERFORMANC E STANDARDS VERIFICATION CRITERIA Means of verification 2. The nursing student conducts Home Visit accordingly 1.Locate the right house, approach to a family and Introduce self and institution Determine by observing or interviewing two students whether the student following steps/tasks: 2.Establish rapport by being courteous, polite and friendly 3.Listens carefully to what family is saying. 4.Observe the following and fill in the family folder: -Physical infrastructure -Cultural background -Head of the Family and Occupation of the family members -Age -Educational level of the family members -socio cultural background 5.Makes appropriate community diagnosis & plans for next visit Checklist and family folder

Standard- 2 continu.. PERFORMANC E STANDARDS 2. The nursing student conducts Home Visit accordingly 7.Gives appropriate health talk. 7.Reinforces pertinent information as per plan Day 3 of home visit ( Termination of IPR with the family) 8.Summarize content with the family & plan for the household visit Plan for the follow-up visit 9.Record the visit with appropriate details of the care rendered to the family. Standard 2 Score VERIFICATION CRITERIA Means of verification Day 2 of Home visit 6.Demonstrates appropriate procedure as planned in last visit.

Standard- 3 PERFORMANCE STANDARDS 3. The nursing student Performs Bag technique at Home VERIFICATION CRITERIA Means of verification Community Bag and procedure Checklist Checkout whether the Community bag is having all the articles or not: - Soaps in a soap dish Hand towel Nail brush - Determine by observing or interviewing two students whether the students following steps/tasks: 2.Upon reaching the home, select a work area which is well lighted and dry where the bag can be placed and set up. Place bag away from children and domestic animals. 3.Spread newspaper on a flat, clean surface on a mat/dhari.Spread newspaper on the mat and place the bag on left hand side of the newspaper.Make a paper bag and place on the right top corner of the bag. 4.Unbutton the outer lining of the bag, remove the hand washing articles.Identify a wash area,seek help from the family and wash hands. 5.Remove apron from the bag and put it on if necessary. 6.Remove necessary supplies and equipment and place on the a clean area on newspaper. Close the bag ( half covered)

Standard- 3 contin. PERFORMAN CE STANDARDS VERIFICATION CRITERIA Means of verificatio n 3. The nursing student Performs Bag technique at Home 7.Remove only those articles that are needed for the planned care. 8.Carry out the required nursing procedure. Place soiled swabs inside the newspaper bag for disposal. 9.Give the newspaper bag with soiled swabs etc., to family for proper disposal by burning. 10.Clean the used articles by using running water. 11.Used Articles that cannot be processed during field visit should be wrapped well with newspaper and to be placed in the outside compartment for further processing. 12. Place articles which are contaminated with infected material in a plastic cover and carry separately for autoclaving. 13.Wash hands and open the bag to return articles into the bag. 14.Use a cotton swab moistened with sprit and wipe outside of used bottle and bowls and replace in the bag. 15.Wash/ Sanitize hands and Close the bag. 16.Fold the newspaper with used side inside and place it in the side pocket and

Standard- 4 PERFORM ANCE STANDAR DS 4. The service provider follows principles of Health Education Techniques on day 2 of home visit. Uses appropriate A.V. aids which are well organized. AV aids selected are self-explanatory & appropriate to the topic. Clears doubts during the session. takes feedback for the session Summarizes the topic clearly at the end after Conclusion VERIFICATION CRITERIA Means of verification Determine by observing or interviewing two students whether the provider following steps/tasks: Organize the health education area Need of the hour topic is selected for health talk Follows the steps of the lesson plan with objectives. Lesson plan Gives Clear explanation on the Subject matter. Uses modulated voice, local language, spontaneous, loud, clear and explains in simple terms Has a healthy control and interaction with the participants, family members encourages discussion Various AV Aids Standard 4 Score

Standard- 5 PERFORMANCE STANDARDS VERIFICATION CRITERIA Means of verification Observe at least one family planning counseling sessions, verify if the student: Greets, Shows client respect and helps the client to feel at ease: - Speaking softly - Encouraging adequate privacy Asks relevant questions to identify client s needs and reasons for visiting the clinic Includes with permission of the client the wife/husband or important family members during the counseling session Assures confidentiality by telling the client that she/he will never share the personal information of the client with anyone. Keeps all the records secured at all the times Addresses any related needs such as protection from sexually transmitted infections, including HIV and support interventions/care based on the need. With a help of contraceptive demonstration kit and charts , educates client about the relevant information(e.g. mechanism, side effects, benefits about contraceptive methods choices available to the client including: o IUCD o Male Condoms o Male Sterilization Observation

Standard- 5 continu PERFORMANCE STANDARDS 5. The Nursing student follows correct counseling techniques to motivate clients for family welfare measures VERIFICATION CRITERIA Means of verification Explains the unpredictable and approximate return of fertility after child birth Rules out pregnancy, assesses risk of STIs and initiates method- specific counseling once client has shown interest in a method or has chosen a method. Performs physical assessment as necessary Provides the method of choice if available or refers woman to the nearest health facility where it is available Thanks the client/couple politely, says goodbye and encourages her to return to the clinic if she has any questions or concerns. score Section 5

Standard-6 PERFORMANCE STANDARDS VERIFICATION CRITERIA Means of verification Under UIP Program the vaccine administered at birth till 9 months of age Ask any student The Provider is able to explain Indira Dhanush initiative of GoI Shows the Site for Measles / MMR vaccination in an infant. Dose of DPT Route in which DPT vaccine is administered Detail on the features of Indradhanush Program Explain the pulse polio programme and number of times it is done in a year. Explain the vaccine carrier use and the colors of Vaccine Potency of the Vial ( VPV ). The temperature in the compartments of the ILR Observe the storage of Vaccine Score 6 nursing student is able to explain on the universal immunization programme (UIP) Schedule for the new born to one year of age Stanadard-6

Standard-7 PERFORMANCE STANDARDS 7. The service provider is able to identify and records danger signs during antenatal assessment at HWC/PHC/CHC(Re fer to appropriate levels of health care setting). VERIFICATION CRITERIA Means of verification O- Asking for each danger sign to pregnant woman during antenatal assessment I- 2 students for how to observe dangers in pregnant woman Warning signs during pregnancy: Warning signs during pregnancy: Vaginal bleeding /leakage Per vagina Respiratory difficulty Fever/ foul smelling discharge Severe headache/blurred vision Generalised swelling of the body, puffiness of face, pitting pedal edema Pain in the abdomen,low urine output Convulsions/loss of consciousness Decreased excessive or absence of fetal movements Performs immediate action in the event of any of the above symptoms and refers to the appropriate setting without any delay. Score Standard-7

Standard-8 PERFORMANCE STANDARDS VERIFICATION CRITERIA Means of verification 8. The nursing student is able to assess and screen for breast abnormalities in women Determine by observing or interviewing two providers whether the provider following steps/tasks: Ensure a separate room/ corner to maintain privacy of woman for counselling and clinical examination. Ensure the room/corner has: } Good light } Chairs, table } IEC posters } Register } Client card Examination table with a small pillow Greet the woman respectfully. If a male doctor/nursing staff is going to examine the client, ensure a female escort is present Find out from woman about following to know if risk factors are present or not: Initiation of her menses before age 12 or menopause after 55 years History of breast feeding practice during post natal period History of Hysterectomy/menpause and whether receiving Hormone Replacement Therapy (HRT) History of irradiation of chest Ask about the maternal/paternal family history of breast or ovary cancer.

Standard-8 continut. PERFORMANCE STANDARDS VERIFICATION CRITERIA Means of verificati on 8. The nursing student is able to assess and screen for breast abnormalities in women Document the demographic details and information obtained from history taking in the register Explain the woman that her breasts will be examined. Assure her that the procedure is painless. Make efforts to ensure that she is fully relaxed and remains at ease during examination.Provide privacy. Steps of CBE: Request the woman to undress from her waist up. Make her sit on the examination table with her arms on her side Wash hands thoroughly and dry them. If necessary, put on new examination or high-level disinfected gloves on both hands Ask the woman to put her hands over her head. Then examine the breasts to note: Any difference in shape, size Dimpling or puckering of skin Pulling in of nipple or other part of breast Itchy, scaly sore or rash on nipple

Standard-8 continut. PERFORMANC E STANDARDS VERIFICATION CRITERIA Means of verificati on 8. The service provider is able to assess and screen for breast abnormalities in women Ask the woman to press her hands on her hips/waist to check if there is any abnormality Observe her breasts while woman has hands over her head and presses her hands on her hips/waist. Check to see if breasts hang evenly Ask her to lie down on the examining table. Place a pillow under her shoulder on the side being examined and place woman s arm over her head Palpate the entire breast using the spiral or Dial of a Clock technique using the pads of three middle fingers Note any lump or tenderness Squeeze the nipple gently using thumb and index finger and checks for any discharge. Palpate for any thickening behind the nipple Repeat these above steps for the other breast Request the woman sit up and raise her arm. Palpate the tail of the breast and check for enlarged lymph nodes or tenderness in each breast. Palpate both the axillae After completing the examination, ask the woman to put her dress back. If the findings are normal, tell the woman everything is fine and when she should

Standard-9 PERFORMANC E STANDARDS VERIFICATION CRITERIA Means of verificati on 9.The service provider performs proper techniques and shows competence in Intramuscular Injection. Determine by observing or interviewing two providers whether the provider following steps/tasks: Arrange articles: -Medication in vial/ampoule - Clean gloves - Sterile syringes and needles. - Sprit swab Perform proper handwash and hygiene throughout the procedure. Provide privacy.Make the patient sit or lie comfortably..Ensure the patient is not empty stomach.Explain the need of injection. Read the medication card. Carefully read the medication name, date of expiry and the content inside for any changes. Prepare dilution if required. Load the syringe and expel the air inside carefully without medication wastage. Explain the purpose and action of the medication to the patient. Select an appropriate administration site. IM Injection Checklist

Standard-9 continu PERFORMA NCE STANDARDS VERIFICATION CRITERIA Means of verificati on 9.The service provider performs proper techniques and shows competence in Intramuscular Injection. Remove the needle cap by pulling it straight off. Hold the syringe in your dominant hand between the thumb and forefinger. Aspirate by slowly (for at least 5 seconds) pulling back on the plunger to determine whether the needle is in a blood vessel. Watch for a flash of pink or red in the syringe. Act fast withdrawing the syringe if blood streaks. If no blood is aspirated, inject the solution slowly. Withdraw the needle smoothly and steadily at the same angle at which it was inserted. Apply gentle pressure at the site with dry gauze. Do not recap the used needle. Engage the safety shield or needle guard, if present. Disinfect the needle with 0.5% chlorine solution. Discard the needle and syringe in the appropriate receptacle. Assist the patient to a position of comfort. Rinse and Remove gloves 0.5% chlorine solution. Wash hands thoroughly after the procedure.

Standard-10 PERFORM ANCE STANDAR DS 10. The Provider is able to perform proper Anthropom etric measureme nt on Pre school children Turn the measuring tape to the mid point of the arm and make the mid arm circumference reading in centimeters Ensure that the child is quiet and prevents movement for a while to get the accurate readings. Interpret the Mid Upper arm findings with the Indian Academy of Pediatrics Standards for the PEM status. Record the findings. VERIFICATION CRITERIA Means of verificatio n School health record Determine by observing or interviewing two providers whether the provider following steps/tasks: Make rapport with the client. Perform anthropometric assessment on the Preschool child -measures mid arm circumference: The provider has got measuring tape without metal cap, the child is made to sit comfortably either on the lap of the mother or on a chair. Bend the arm at the right angle on the abdomen of the child, Measure the length of the arm from acromion process to the olecranon process. Mark the centimeters and take the exact mid point.

Standard-11 PERFORMA NCE STANDARDS VERIFICATION CRITERIA Means of verificatio n School Health record 11. The nursing student is able to perform the Health Assessment on school going child Determine by observing or interviewing two providers whether the provider following steps/tasks: Make rapport with the client. Height Measurement with stadiometer or with proper markings on the wall. Weight Measurement with electronic or ordinary weighing scale after correcting the zero error Calculate the B.M.I Plans a Schedule for School Health Assessment and informs the school well ahead of time Registration of the eligible of the student and the referral process Number of Referrals done in the last visit Standard-11 score

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