INTERNSHIP LOGBOOK

TAIBAH UNIVERSITY FACULTY OF NURSING

EST.2003 DEPARTMENT OF INTERNSHIP

Phone No.: (+966) (0)14 861 8888 E-mail: [email protected]

INTERNSHIP

LOGBOOK BACHELOR’S SCIENCE OF NURSING PROGRAM

1

TAIBAH UNIVERSITY

FACULTY OF NURSING EST.2003

DEPARTMENT OF INTERNSHIP

Contributors • Dr. Khalid A. Aljohani

Assistant Professor of Disease Management

• Dr. Mohammed S. Aljohani Assistant Professor of Emergency Nursing

• Mr. Abdullah Alhojaili MSc RN

Academic Affairs Supervisor

• Mr. Abdulrhman A. Aljohani Supervisor of internship unit

• Dr. Khaled M. Al-Sayaghi Associate Professor of Critical Care and Emergency Nursing

• Dr. Du'aa Alsayed

Assistant Professor of Geriatric Nursing

• Dr. Howida A. Hassan Associate Professor of Maternity Nursing

• Dr. Inas A. Ebied

Assistant Professor of Mental Health Nursing

• Dr. Khadega A. Alhefnawy Assistant Professor of Medical and Surgical Nursing

Reviewers

• Dr. Hammad A. Fadlalmola Associate Professor of Community Health Nursing

• Emtenan M. Alahmadi BSN, RN Head of Nursing Education Department Meeqat General Hospital, Madinah

• Glezzeelyne P. Pascua, RN, RM, MSN

Nurse Educator King Fahad Hospital, Madinah

• Rahima M. Salendab BSN, RN Clinical Audit Nurse Meeqat General Hospital, Madinah

• Wael A. Aljohani BSN, RN, MCC

Head of Nursing Education & Research Department K.F.H, Madinah

• Mohammed O. Kabli RN, BSN Staff Nurse 1 MNG-HA, Prince Mohammed Bin Abdul Aziz Hospital, Madinah, Saudi Arabia.

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TAIBAH UNIVERSITY



Intern’s Personal Information

Intern’s Name University ID No. National ID No. Starting Date

Phone No. Ending Date E-mail Signature

4×6

STAMP

3

TAIBAH UNIVERSITY



Foreword

* The internship year is the fifth and last year in Bachelor of Nursing degree program at Taibah- University-College of Nursing. It is a professional nursing registration requirement by the Saudi Commission for Health Specialties. Students who did not complete their internship year successfully will not be able to practice nursing in Saudi Arabia.

* The internship year is a structured clinical rotation aimed to support student to have first-hand clinical nursing experience, which help student's transition from academic education into real nursing practice in different clinical settings. According to the literature, nursing interns tends to work in the training hospital after their graduation. Therefore, training organization may invest in nursing interns and recruit those who fits their employment needs.

* The nursing internship logbook was structured in accordance with the Bachelor of Nursing learning outcomes and went through several modifications by faculty members and stakeholders from the internship clinical placements' education staff.

*** Finally, it is highly appreciated to contact Nursing College internship unit if there is a need for further clarification or to overcome potential training challenges

First contact Internship Unit E-mail: [email protected]

Second contact Nursing College E-mail: [email protected]

Wish you all the best,

Dr. Khalid Aljohani

Dean of Nursing College

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TAIBAH UNIVERSITY



Taibah University vision, mission, and values

Ø Vision Internationally, recognized, comprehensive, Saudi university dedicated to excellence in teaching, research, and community service.

Ø Mission Contribute to society building that promotes sustainable development, knowledge economies through excellence education, quality research and community partnership in a stimulating environment for learning and creativity.

Ø Values Taibah University is committed in all its activities to consolidate a set of values, including:

• Responsibility • Respect & Appreciation • Transparency &

Accountability • Accountable Freedom • Quality & Excellence

• Creativity • Leadership • Proactivity • Equality • Future-orientation

Nursing College vision, mission, and values

Ø Vision Leadership in nursing education and excellence in scientific research and community service locally and regionally.

Ø Mission Provide the community with scientifically and skillfully qualified nurses through a stimulating educational and research environment that contributes to the development and service of the community.

Ø Values Taibah University is committed in all its activities to consolidate a set of values, including:

• Transparency • Teamwork • Responsibility • Professionalism • Creativity and Innovation

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Completed Rotations Achieved by the Nurse Intern

Hospitals Abbreviations Madinah General Hospital

(MGH)

King Faisal Specialist Hospital&

Research center

(KFSH&RC)

Prince Mohammed Bin

Abdul-Aziz Hospital

(NGHA-PMBAH)

Al-Amal Psychiatric Hospital

(APH)

Maternity & Children Hospital

(MCH)

Ohud Hospital (OH)

King Fahad Hospital Madinah

(KFHM)

AL-Meqat Hospital (MH) King Fahad Medical City-

Riyadh (KFMC)

Completed

rotation

Name of Rotation

Period

Duration in weeks

Hospital

ü Start End

Department of Psychiatry and Mental

Health.

Primary Health Care Center (PHC)

Medical Department /WARD

Surgical Department /WARD

Emergency Department (ER)

Intensive Care Unit (ICU)

Operation Room (OR)

Hemodialysis Unit

Pediatric Department / WARD

Obstetrics & Gynecology Department

Elective rotation:

Overall Internship

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Introduction

Based on Miller's model of assessment in clinical skills/ competence/ performance, the nursing college guided interns from their early days of Bachelor of Nursing Study until they fulfilled their academic requirements learn about nursing skills that are illustrated in this document. All interns went through the first three stages that are: Knows, Knows How and Show. The internship comes to confirm interns' capability to accomplish the fourth stage of "Does" that in turn validate interns'

competency and their successful transition into practice.

This document is divided into two main sections:

Section 1: Internship General Information

Section 2: Internship Clinical Skills

**This logbook considered as a document and it is under the responsibility of the intern. Once internship training accomplished. Interns must return the document to Internship

department as an evidence of their professional authenticity and graduation. **

**Preceptors/Educators are required to sign after each satisfactory clinical skill performance. **

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Section 1: Internship General Information General Objectives for the Internship Program

1. Enable the nurse intern to apply learned theoretical knowledge into practice in various clinical setting.

2. Improve and refine the intern's communication skill and professional relationships with patients and members of the multidisciplinary health care providers.

3. Improve the nurse intern ability to act independently and as a member of a team in providing professional nursing care.

4. Acquaint the nurse intern with various hospital policies and procedures. 5. Help the nurse intern to develop the necessary skills and competencies that make him/her safe

practitioners. Purpose of the Log-Book

1. To emphasize major competencies and clinical skills in each unit rotation. 2. To assist in the follow up / progress of nurse intern throughout internship program. 3. To support intern's performance integrated into practice phase (Miller, 1990).

Assignments Method's :

Assignments Due Dates clinical placement [ 70% ] One per rotation Case study discussion/presentation [ 10 % ] One per intenship Case study / rotation [ 15 % ] For 6 department Reflective journal [ 5 % ] One per rotation Preceptor feedback [ requirment ] One per rotation

Internship Training Period The bachelor nursing internship program IS 48 WEEKS EXCLUDING HOLIDAYS. Expected weekly hours are 40 hours.

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Internship Clinical Rotations (Time Distribution) of bachelor’s Program

Main Departments Total No. of weeks

Specific Areas

Rotations in

Weeks (male)

Rotations in

Weeks (female) Medical Department 8 General Medical

Department 6 6

Hemodialysis (HD) Unit (if available)

2 2

Surgical Department 8 General Surgical Department

6 6

Operation Room (OR) 2 2 Intensive Care Unit (ICU)/

CCU 4 ICU 6 4

Emergency Room 4 ER 6 4 Psychiatric Department 4 Inpatient 2 2

Emergency Room 2 2 Primary Health Care

Center 4 Well- baby Clinic

&Vaccination 2 2

OPD 2 2 Pediatric Department 4 Emergency Room &

NICU & PICU 4 4

Obstetrics & Gynecology 4 Gyne ward - 1 GICU - 1

-Postnatal Ward - 1 Labour Room (LR) - 1

Clinical Elective Rotation* 8 8 8

*Clinical Elective Rotation (8 weeks): - Operation Room (OR). - Oncology Ward. - Burn Unit. - Primary Health Care Center - Emergency Department - Psychiatric Department - Hemodialysis (HD). - Pediatric Department - Intensive Care Unit (ICU) / Intensive cardiac Care Unit (CCU).

• The intern must define the elective area at least 2 months ahead to allow internship

department to communicate with the health care agencies.

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Instructions for the Preceptor All clinical instructors/preceptors need to follow the following key assessment procedure in assessing nurse interns' performance on each skill in the logbook.

• Level of Performance: The nurse intern performed the skill task independently under supervision (including teamwork skills, as part of the team).

Performance is measured on two dichotomies with a third option if there is no chance to perform the clinical skill during the clinical placement:

• SATISFACTORY: the nurse intern completed the skill task successfully. • UNSATISFACTORY: the nurse intern failed to perform the skill task successfully…. • Not Applicable: the skill is either not applicable or not available at clinical setting and the nurse

intern was not able to observe and perform it. Once selected, the nurse intern will not be assessed for this skill.

For each skill/task performed by intern, the immediate trainer (clinical instructor/ preceptor/staff nurse trainer) will sign (with initials and date) in the appropriate column under the level of performance (see the example).

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Section 2: Internship Clinical Skills

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Basic Nursing Care Skills “IPSG” its repeated skills that trainee should do each rotation. However, it should be signed by one preceptor to maintain standard performance level.

**APPROVAL**

POSITION NAME SIGNATURE DATE

HEAD NURSE/ CHARGE NURSE/ NURSING EDUCATOR

HEAD OF CONTINUING EDUCATION

Clinical Skill/Task Level of Performance Not Applicable SATISFACTO

RY UNSATISFA

CTORY Measure and Document the Vital Signs

• Performing admission procedures. • Performing discharge procedures. • Receiving and handover of patient (end of shift

endorsement).

• Complying with infection control and safety measures.

• Performing documentation. • Complying with hospital policies and procedures. • Adhering to professional standers of legal and ethical

practices in providing culturally sensitive care that respects patients' rights, values customs, and religious beliefs.

• Utilizing therapeutic communication skills.

International Patient Safety Goals (IPSG)

• Patient Identification

• ISBAR Communication (Identify, Situation, Background, Assessment and Recommendation)

• Safety OF High Alert Medication

• Ensure Correct Site, Correct Procedure, Correct Patient Surgery

• Reduce Risk OF Health Care Associated Infection: a) Personal Protective Equipment b) Hand Hygiene c) Immunization (Influenza & Meningitis)

• Fall Precautions

STAMP

12



Medical Department /WARD

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Medical Department /WARD Rotation weeks Male 6/w Female 6/w

Objectives of Training in the Medical Department. By the end of training in the medical department, the nurse intern will be able to:

1. Follow rules and regulation of infection control. 2. Demonstrate skill of history taking and physical examination. 3. Use the nursing process in providing patient care. 4. Perform the routine nursing care (hygienic, feeding, positioning, elimination) 5. Prepare and assist with diagnostic and therapeutic procedures in medical department. 6. Demonstrate a basic level of proficiency in prerequisite mathematical calculations for

medication administration. 7. Demonstrate skills of medication &IV therapy administration. 8. Safely initiate, maintain, and terminate the hemodialysis treatment. 9. Adhere to hospital policies and procedures.

For each skill/task performed by intern, the immediate trainer (clinical instructor/preceptor/staff nurse trainer) will sign (with initials and date) in the appropriate column under the level of

performance.

Clinical Skill/Tasks

Level of Performance

Not Applicable

SATISFACTORY

UNSATISFACTORY

Measure and Document the Vital Signs • Axillary/oral temperature • Radial pulse (rate/rhythm/force/volume) & apical pulse • Use of pulse amplitude ** • Respiration rate/character/pattern • Blood pressure (manual and automatic) • Pain assessment / score • Application of pulse oximeter • Documentation

14



Clinical Skill/Task Level of Performance Not

Applicable SATISFACTORY

UNSATISFACTORY

Utilize the Nursing Process in the Care of the Patient • Obtains comprehensive patient’s health history. • Perform Complete Physical Assessment

- HEENT assessment - Respiratory assessment. - Cardiovascular assessment. - Neurological assessment and GCS. - Musculo-skeletal assessment. - GIT and abdominal assessment. - Genitourinary assessment.

• Formulate nursing diagnosis and sets attainable and measurable objectives.

• Develop a nursing care plan appropriate for identified nursing diagnoses

• Implement the nursing care plan. • Evaluate effectiveness of the nursing care.



UNSATISFACTORY

Prepare and Administer Medications • Calculate medication dosage • Per Orem (by mouth). • Per NGT • Nebulization / inhalation • Per rectum • Subcutaneous injections. • Intravenous injections. • Intramuscular injections. • Topical: skin, eye, nose, and ear. • Mixing two insulins in one syringe • Chemotherapy • High Alert / LASA medication (proper handling)

Verified by 2 nurses

15





UNSATISFACTORY

Collect the Samples (Specimen) for Laboratory Tests • Blood samples.

• Blood culture.

• Swabs: ear, nose, throat, wound.

• Drainage fluid sample.

• Sputum sample by expectoration.

• Urine samples: random, mid-stream clean catch, first morning, 24 hours collection and catheter sample collection.

• Stool sample.



Unsatisfactory

Assist with Safe Preparation and Post Procedure Care for the following Procedures • X ray and ultrasound.

• CT Scan/MRI.

• Endoscope/Bronchoscope.

Prepare and Perform the Following Procedures: • Recording the 12-leads ECG.

• Gastric tube (nursing care, and removal).

• Bolus enteral tube feeding.

• Blood sugar monitoring by gulco-check machine.

• Urinary catheters (nursing care & removal).

• Condom catheter to male patient.

• Urine screening for sugar, albumin, acetone.

• Bed making (unoccupied bed)

• Bed making (occupied bed)

Understanding Code Blue Management

16



Provide Nursing Care and Management of Patient with:

• Cardiovascular disorders (such as IHD, heart failure, hypertension, cardiomyopathy, pericarditis, pericardial effusion, peripheral vascular disorders, etc.)

• Respiratory disorders (such as COPD, asthma, pneumonia, PE, pleural effusion, fibrosis, etc.).

• Neurological disorders (such as stroke etc.) • Endocrine disorders (e.g. DM etc.) • Hematological disorders (e.g. anemia etc.) • Gastrointestinal disorders (e.g. liver disease, etc.) • Renal failure/hemodialysis.

**APPROVAL**




STAMP

17



زایتمالا ضیرمت بردتم مییقت جذومن Nursing Intern’s Evaluation Form

بیردتلا ةدم

Rotation period To From ىلإ نم

مسقلا Department/Ward

بیردتلا ةھج Institution

ةیوھلا مقر ID No.

بردتملا مسإ Intern’s

name

مایألا ددع

Days quantity بایغلا مایأ

Absences days رذعب بایغ

Absence with Excuse رذع نودب بایغ

Absence without Excuse اھضیوعت مت يتلا مایألا

Days to coverup Absences مایألا ددع يلامجإ

Total Days

تاظحالملا Notes &Comments

خیراتلا Date

عیقوتلا Signature

بردملا مسإ Preceptor’s Name

ریرقتلا ىلع ةقداصملا Report Approval

خیراتلا Date

بصنملا Position

الماك مسألا Full Name

STAMP

ةجردلا Score

%

مییقتلا طاقن Assessment Items

%٢٤

میلعتلا يف ةینفلا ةءافكلا Interest to Learn

13%

لمعلا و روضحلا يف طابضنإلا Punctuality

13%

ةمظنألاو تامیلعتلاب دیقتلا Following the rules & regulations

١0%

ملعتلا يف ةیدجلاو مامتھإلا Interest in learning

%٩

ةیلوؤسملا سحب يلحتلا Responsibility

%٩

میقعتلا تاءارجإب مازتلإلا Following infection prevention

standard

%٨ ىضرملا عم دیجلا كولسلا

Behavior with Patient

%٧

كولسلا نسح و يصخشلا رھظملاب مامتھإلا Personal Appearance & Behavior

%٧

دقنلا و حصنلا لوبق Acceptance Of criticism

ةیئاھنلا ةجیتنلا Final Score

18



Hemodialysis Unit

19



Hemodialysis Unit Rotation weeks Male 2/w Female2/w


performance

Clinical Skill/Task Level of Performance Not Applicable SATISFACT

ORY UNSATISFACT

ORY

Basic nursing care skills (refer to page 11)

Preparation of patient to hemodialysis. Pre-dialysis patient assessment.



UNSATISFACTORY

Set up and Test the Delivery System. • Perform system start up procedure

• Priming dialyzer

• Perform alarm systems function test

• Perform manual conductivity test

• Perform manual temperature test

• Perform manual pH test

• Perform manual pressure holding test.

• Perform basic operator troubleshooting

• Preparation of patient to hemodialysis. • Measures patient’s body weight & vital signs

• Administers heparin bolus through venous line.



UNSATISFACTORY

Perform the Vascular Access Procedures. • Assesses access for function and lack of pathology.

• Cleans needle site with appropriate disinfectant.

20



• Cannulates fistula at 25o angle and AV graft at 45o

angle.

• Pre-dialysis CVC care and dressing change.

Connect patient to machine and initiates dialysis with internal vascular access/with CVC

Collect Blood Specimens



UNSATISFACTORY

Provide Care and Monitor the Patient and Equipment During Hemodialysis. • Systemic assessment of patient and the patient

subjective response to treatment.

• Monitor volume status.

• Monitor vascular access function.

• Monitor arterial and venous pressures and blood flow rate.

• Management of anticoagulation.

• Ultrafiltration calculation

Administer mannitol, blood & blood product.



UNSATISFACTORY

Perform Machine Alarm Troubleshooting Procedures • Blood leak alarm.

• Arterial pressure alarm.

• Venous pressure alarm.

• Conductivity alarm.

• Ultrafiltration alarm.

• High temperature alarm.

• Air/foam detector alarm.

• Power failure alarm.

• Blood pump alarm.

21





UNSATISFACTORY

Management of the Dialysis Patient With • Fluid overload/ hypertension. • Hypotension. • Disequilibrium syndrome. • Hyperkalemia. • Seizures / muscle cramps • Unsatisfactory blood flow rate from catheter • Filter blood leak • Air embolus • Hemolysis. • Pyrogenic reaction. • Chest pain. • Cardiopulmonary arrest.



UNSATISFACTORY

Properly Discontinues Dialysis with Internal Vascular Access/with CVC. • Return of blood.

• Performs post dialysis vascular access care.

• Properly assesses access for function and cessation of bleeding from needle sites.

• Measures patient’s body weight & vital signs



UNSATISFACTORY

Perform the Equipment Clean Up and Sterilization. • Properly cleans and disinfects exterior of machine. • Proper Handling of disposable supplies

22





UNSATISFACTORY

Peritoneal Dialysis Prepare and assist with peritoneal dialysis initiation. Care and monitor patient during peritoneal dialysis Care and maintenance of exit sites for peritoneal dialysis Obtain blood sample and follow laboratory blood works

**APPROVAL**




STAMP

23




بیردتلا ةدم Rotation period To From ىلإ نم





name

مایألا ددع Days quantity

بایغلا مایأ Absences days

رذعب بایغ Absence with Excuse

رذع نودب بایغ Absence with out Excuse

اھضیوعت مت يتلا مایألا Days to coverup Absences

مایألا ددع يلامجإ Total Days


خیراتلا Date




خیراتلا Date



ةجردلا Score

%


%٢٤


13%


13%


10%


%٩


%٩


standard



%٧


%٧



STAMP

24



SURGICAL DEPARTMENT/ WARD

25



SURGICAL DEPARTMENT/ WARD

Rotation weeks Male 6/w Female 6/w. Objectives of training in the Surgical Department

By the end of the training in the surgical department, the nurse intern will be able to: 1. Provide preoperative nursing care. 2. Provide immediate and routine post-operative nursing care. 3. Provide the care for patient with common surgical disorders. 4. Prepare and assist with diagnostic and therapeutic procedures in surgical department. 5. Provide direct nursing care for patients with common surgical interventions. 6. Provide wound care and the care for diabetic foot. 7. Demonstrate skills and roles of scrub nurse and circulating nurse in operation room.


performance.



UNSATISFACTORY


Safely lift a patient: • Bed to chair/chair to bed.

• Bed to trolley/Trolley to bed.

• Use a “draw sheet” effectively

Transport patients on a stretcher

Transport patients in wheelchair

Apply the external heating/cooling device (use of hyper/hypothermia blanket).

Insert, maintain & remove the peripheral IV cannula.

Clinical Skill/Task Level of Performance Not Applicable SATISFACTORY UNSATISFACTORY

Perform blood and blood products transfusion. • Whole blood • PRBCs • Platelets • Fresh frozen plasma.

26




Applicable SATISFACTORY UNSATISFACTORY

Preoperative Management. • Proper Patient Identification

• Consent and organize chest x-rays, ECG, blood work and check pre-operative checklist.

• Teach patient.

• Health teaching / explain the procedure to the patient.

• Prepare the patient’s skin

• Prepare and administer the enema.

• Perform specific preoperative preparation.

• Transfer patients to OR and from recovery room.

• Signed-in

• Time-out



UNSATISFACTORY

Post-Operative Management • Receive patient from OR and position him in bed • Signed-out • Provide the immediate post-operative care • Assess the pain level. • Assess the neurovascular status. • Guide the patient using of incentive spirometry. • Measure fluid intake and output. • Assist with early ambulation

27





UNSATISFACTORY

Wound Care and Surgical Dressing. • Assess wound and select appropriate dressing

materials

• Setup of sterile surgical field add the supplies and pour solution aseptically.

• Change surgical dressing aseptically. • Cleanse, irrigate, pack, and dress the open wound. • Obtain wound culture (swab for C/S). • Monitor and care of drains devices. • Remove drain • Remove sutures and staples. • Care and change dressing for diabetic foot. • Assess and record the stoma condition. • Irrigate colostomy and perform stoma site care • Apply/change the stoma appliances for the

colostomy (bags, wax).

• Provide the care of the patient with a chest tube and underwater seal drainage system.

• Prepare and assist with pleural/ mediastinal chest tube removal.



UNSATISFACTORY

Renal/Urologic Management. • Nursing care and maintain the three-way indwelling

urinary catheter.

• Perform and maintain intermittent and continuous closed bladder irrigation

• Provide the care of nephrostomy tube • Provide care of urostomy and urinary diversions • Prepare & assist with suprapubic catheter insertion • Provide the care of the suprapubic catheter.

28





UNSATISFACTORY

Safe Preparation and Post Procedure Care for the Following Procedures • Colonoscopy • Upper GI Series (barium swallows) • Lower GI Series (barium enema) • Intravenous urography (IVP), cystography, and

renal angiography

• KUB and ultrasonography. • Biopsy (renal and ureteral brush biopsy). • Extracorporeal shock wave lithotripsy (ESWL) • Bronchoscopy • Endoscopy • Cystoscopy



UNSATISFACTORY

Orthopedic procedures: • Prepare patient for traction application • Maintain and care of traction (skin and skeletal) • Provide the pin care. • Maintain and care of spinal skeletal traction

(skeletal tongs or calipers, and halo device)

• Maintain and care of cast • Apply the bandages and slings



UNSATISFACTORY

Provide Nursing Management of Patient with: • Post open cardiac surgery • Thoracotomy/Lobectomy/Pneumonectomy • Head injury. • Spinal cord injury • Craniotomy and brain surgeries

29



• Amputation • Pinned fractures ( Internal or external fixator

devices)

• Total hip/Total knee replacement • Paralytic ileus/Bowel obstruction • GI surgery • Nephrectomy • Renal transplant • Transurethral resection of prostate (TURP). • Urinary diversion • Thyroidectomy • Traumatic wounds

**APPROVAL**




STAMP

30









name

مایألا ددع Days quantity

بایغلا مایأ Absences days

رذعب بایغ Absence with Excuse

رذع نودب بایغ Absence without Excuse

اھضیوعت مت يتلا مایألا Days to coverup Absences

مایألا ددع يلامجإ Total Days


خیراتلا Date




خیراتلا Date



STAMP

ةجردلا Score

%


%٢٤


13%


13%


10%


%٩


%٩


standard



%٧


%٧



31



OPRATION ROOMS DEPARTMINT

(OR)

32



OPRATION ROOMS DEPARTMINT (OR) Rotation weeks Male 2/w Female 2/w


performance.



UNSATISFACTORY


Before the Operation

• Proper Patient Identification

• Receive patient from surgical department and provide psycho-social support for patients.

• Prepare operation table.

• Signed-in

• Prepare operation instrument tables/trolleys (sterile field), sheets and instruments (circulating nurse).

• Anticipates, provides, and arranges properly the needed supplies and equipment for the operation.

• Endoscopic Retrograde Cholangiopancreatography (ERCP).



UNSATISFACTORY

• Perform vital signs and hemodynamic monitoring.

• Position patients for operative procedures – standard surgical positions.

• Perform surgical scrubbing using correct technique and timeframe (scrub nurse)

• Perform sterile gowning and gloving (scrub nurse)

• Time-out

33





UNSATISFACTORY

During the Operation:

• Keeps track of instruments as to location and numbers (scrub nurse/circulating nurse)

• Anticipates the needs of the surgeon and the surgical team with confidence (scrub nurse/circulating nurse)

• Accurately counts and promptly records sponges and instruments before the cutting time, and the closing time.

• Maintain sterile field-aseptic technique (maintains sterility of supplies, equipment, and area always)

After the Operation:

• Accurately counts and promptly records sponges and instruments after closing time (scrub nurse/circulating nurse).

• Helps in application of dressing.

• Provide immediate post-operative care.

• Signed-out

• Assist in cleaning the OR suite/theater after use, in preparation the OR for the next case/use.

• Disposes waste material properly

**VERIFICATION**




STAMP

34










name

مایألا ددع






Total Days


خیراتلا Date




خیراتلا Date



STAMP

ةجردلا Score

%


%٢٤


13%


13%


10%


%٩


%٩


standard



%٧


%٧



35



EMERIGENCY DEPARTMENT (ER)

36



EMERIGENCY DEPARTMENT (ER) Rotation weeks Male 6/w Female 4/w

Objectives of Emergency Department: By the end of the training in the department of emergency, the nurse intern will be able to:

1. Receive patient at triage area and categorize them. 2. Identify the appropriate action for the emergency. 3. Provide nursing care for patients with common emergency problem. 4. Prepare equipment and assist in emergency procedures. 5. Document clearly according to hospital policy. 6. Calculate and administer the common emergency medication. 7. Communicate effectively with patients and their families, and other colleagues. 8. Develop leadership skills.


performance.



UNSATISFACTORY


Check crash cart contents, test the defibrillator safely, and accurately reporting any discrepancies.

Gastric wash/lavage.

Clinical Skill/Task Level of Performance Not Applicable SATISFACTORY UNSATISFACTORY

Perform the Emergency Assessment • Primary Assessment (A, B, C, D, E)

• Secondary Assessment

Perform the Triaging: able to demonstrate & assist in prioritizing patients management

37





UNSATISFACTORY

Life Saving Interventions • Perform BLS procedures

• Provide the bag-valve-mask ventilation

• Participate in ACLS and administer ACLS drugs

• Prepare and assist with defibrillation / cardioversion



UNSATISFACTORY

Airway Management • Insert the nasopharyngeal airway.

• Insert the oropharyngeal airway.

• Prepare and assist with the tracheal intubation

• Prepare and assist with the tracheostomy

• Insert the laryngeal mask airway

• Perform the naso- and oropharyngeal suctioning.

• Perform the endotracheal tube and tracheostomy suctioning.



UNSATISFACTORY

Insert the peripheral IV catheter and withdraw blood sample.

Priming and regulating IV fluid

Provide the IV fluid resuscitation

Prepare and assist with insertion and set up of the central venous line and the Quinton catheter.

Prepare and assist with cutdown.

Perform Allen's test and obtain arterial blood sample

Interpret arterial blood gases results

38



Apply pulse oximetry to the patient

Measure the peak expiratory flow rate by the peak expiratory flow meter



UNSATISFACTORY

Provide O2 therapy by • Nasal cannula.

• Simple face mask.

• Rebreathing and Non-Rebreathing Mask

• Venturi mask.

Administer medication by inhalers and nebulizer.



UNSATISFACTORY

Administer common emergency medications.

Administer the thrombolytic therapy.

Prepare chest drainage system (Pleur-evac drainage)

Prepare (patient and equipment) and assist with chest tube insertion

Prepare patient and equipment and assist with pericardiocentesis.

Prepare and assist with esophagogastric Tamponade Tube insertion (Seng taken-Blakemore tube).

Perform the saline gastric lavage.

Provide the care for open and traumatic wound.

Set up suture tray and assist with wound closure (by suturing and staples).

Perform eye irrigation and apply the eye patch.

Perform nasal packing

Immobilize cervical spine by cervical collar.

Immobilize spine with the long spine board.

39



Stabilize fractures with splints (including cast splint)

Receiving and transferring patient from the ambulance or private car to the emergency trolley.

**VERIFICATION**




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name

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41



INTENSIVE CARE UNIT (ICU)

42



INTENSIVE CARE UNIT (ICU) Rotation weeks Male 6/w Female 4/w

Objectives of Intensive Care Unit Rotation. Upon completion of the clinical training in the ICU, the nurse intern will be able to:

1. Demonstrate high technical skills in caring for critically ill patients in ICUs. 2. Prioritize care to critical care patients. 3. Demonstrate confidence in clinical decision making within the professional nursing role in

the critical care setting. 4. Integrate knowledge from nursing science in the nursing care of critically ill patient. 5. Prepare equipment and assist in critical care procedures. 6. Calculate and administer the common ICU medication. 7. Communicate effectively with patients and their families and colleagues.


performance.

Clinical Skill/Task Level of Performance Not Applicable SATISFACTOR

Y UNSATISFACT

ORY

Basic nursing care skills (refer to page 11) Perform endotracheal tube care (changing position, changing the tie and fixation)

Perform tracheostomy and tracheostomy tube care.

Perform ETT/tracheostomy tube suctioning.

Provide endotracheal/ tracheostomy tube cuff care.

Perform chest physiotherapy.

Collect sputum sample by suction.

Set up ventilator, adjust the ventilator setting as prescribed and test the alarm system.

Initiate invasive & noninvasive mechanical ventilation as prescribed.

Provide the care of mechanically ventilated patient.

Troubleshooting the ventilator alarms.

Assist in weaning from mechanical ventilation.

Perform extubating according to physician order.

43



Provide O2 by tracheotomy mask and T-piece Monitor the end-tidal CO2 (capnograph monitoring) Set up cardiac monitor, adjust and test the alarm system and initiate the cardiac monitoring.

Perform basic 12 lead ECG interpretation and basic arrhythmia interpretation.

Prepare ICU bed for post-cardiac surgery patient Receive the post-cardiac surgery patient.



UNSATISFACTORY

Prepare and assist with insertion and set up of: • Arterial line • PA catheter/Swan-Ganz catheter. • Temporary pacemaker (transcutaneous

/transvenous).

Set up and zeroing a pressure transducer and monitoring system for the CVP and arterial line.

Obtains CVP readings using a water manometer and pressure monitor.

Provide care for the central venous line/PA catheter.

Provide care for arterial catheter and arterial line.

Flush central venous line

Draw blood from central venous line/ PA catheter

Administer IV push medications and fluids through the central venous line.

Draw blood from arterial line

Remove central venous line.

Remove arterial line

Provide care of patient with a pacemaker Provide the pre/post angioplasty /cardiac Cath (PCI)

Use IV infusion pumps and IV syringe pumps

Prepare and set up the CRRT system and machine.

Initiate the CRRT

Provide the care of patient on CRRT Provide care for patient with increased ICP.

44



Obtains ICP readings accurately using ICP monitor. Provide care of patient undergoing ICP monitoring

Administer continuous enteral feeding by pump

Administer of enteral feeding through gastrostomy/ jejunostomy tube

Administer TPN, PPN and lipids.

Provide perineal care

Provide eye care

Provide oral care

Provide hair care

Provide complete/partial bed bath. Provide care for patients with respiratory disorders (such as respiratory failure, ARDS, pulmonary edema, pulmonary embolism, severe asthma, and COPD exacerbation).

Provide care for patients with cardiovascular disorders (such as ACS, post cardiac arrest, and immediate post open-heart surgery).

Provide care for patients with neurological disorders (such as stroke/coma, brain injury, brain edema, increased ICP, and spinal cord injury).

Provide care for patients with liver failure/hepatic coma, severe acute pancreatitis, and paralytic ileus.

Provide care for patient with diabetic comas. Provide care for patient with renal disorders: acute renal failure and renal transplant

Provide care for patient with shock and multi-system organ failure.

**VERIFICATION**




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name

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46



Pediatric Department/WARD

47



Pediatric Department/WARD Rotation weeks Male 4/w Female 4/w

Objectives of training in the Pediatric Department/WARD By the end of the training in the pediatric department, the nurse intern will be able to:

1- Assess growth and anthropometrics & recording on graph. 2- Demonstrate skills of history taking (assessment of newborn, preterm & pediatric). 3- Perform physical examination for every child correctly and completely. 4- Assess the signs and symptoms of common serious childhood illnesses. 5- Perform nursing care for common pediatric medical and surgical disorders. 6- Assist in common diagnostic and therapeutic procedures. 7- Provide health teaching to the parent.


performance.



UNSATISFACTORY


Proper Patient Identification

Take pediatric health history.

Perform complete pediatric physical assessment.



UNSATISFACTORY

Assess infant/child growth & development: • Weight and height. • Head, chest, and abdominal circumference. • Record on growth graph.

48





UNSATISFACTORY

Measure & document pediatric vital signs: • Pulse • Respiration, • Blood pressure. • Temperature: axillary and rectal by glass and

electronic thermometer, and by tympanic probe.

Apply pulse oximeter to the neonate, infant and child

Administer oxygen therapy by simple face mask, nasal cannula, and head box/hood.

Obtain capillary blood sample from the heel.

Perform vein puncture and withdraw blood sample

Insertion of peripheral IV cannula

Provide the care of IV Hep-lock/cannula and perform cannula flashing.

Prim tubing & regulate the flow rate of IV fluids.

Calculate the pediatric medication dosage



UNSATISFACTORY

Prepare and administer medications: • Oral

• Rectal

• Parenteral medications (SC, IV and IM).

• By nebulizer/inhaler

Prepare and administer the ORS.

Prepare and provide bottle feeding.

Insert, care, and remove gastric tube.

Prepare and administer gavage feeding

Administer TPN/PPN as prescribed.

Provide the phototherapy.

49



Use radiant warmer.

Perform chest physiotherapy.

Perform passive exercise/guide the child for active exercise



UNSATISFACTORY

Perform the pediatric/neonate hygiene safely • Complete/partial bath. • Mouth care • Eye care. • Diaper care.

Make up a bed/cot.

Use bedrails appropriately and use restraints when required

Lift and transport pediatric patient.

Provide nursing management for child with common medical disorders.

Provide pre-operative and post-operative care for the child with common surgical disorders.

Prepare pediatric patient for discharge (give patient & parents health teaching about appointments, medications, diet & any special instruction).

**Verification**




STAMP

50



زایتمالا ضیرمت بردتم مییقت جذومن

nursing Intern’s Evaluation Form






name

مایألا ددع






Total Days


خیراتلا Date




خیراتلا Date


الماك مسالا Full Name

STAMP

ةجردلا Score

%


%٢٤


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13%


10%


%٩


%٩


standard



%٧

كولسلا نسحو يصخشلا رھظملاب مامتھإلا Personal Appearance & Behavior

%٧

دقنلاو حصنلا لوبق Acceptance Of criticism


51



Maternity/Obstetric Department FOR FEMALE ONLY

52



Maternity/Obstetric Department Rotation 4 weeks

Objectives of the Maternity/Obstetric Department By the end of maternity/obstetric clinical training, the nurse intern will be able to:

1. Take complete history and perform physical assessment for pregnant woman and mother’s in the postpartum period.

2. Formulate nursing diagnosis addressing woman unmet need according to priorities. 3. Perform nursing interventions and nursing care based upon the formulated plans. 4. Provide nursing care by applying nursing process for low and high risk pregnant women. 5. Provide nursing care for post-partum and gynecology women. 6. Provide antenatal and postnatal health education regarding breast feeding, schedule of

immunization, family planning methods, nutrition and exercise.


performance.



UNSATISFACTORY




UNSATISFACTORY

Antenatal • Measure and record vital signs • Palpate abdomen (abd. maneuver) and determine the

fetal position

• Monitor contraction and fetal heart rate using Pinard • Test urine • Observe and recognize blood loss through vagina (P.V

loss)

53





UNSATISFACTORY

Care of high-risk patients: • Elective LSC- preparing for CS • Provide pre & post-operative care • Observing vaginal bleeding • Changing dressing • Assisting with Prostin insertion •



UNSATISFACTORY

Postnatal care • Monitoring vital signs and pain level • Checking uterine involution & perform uterine

massage

• Observe for vaginal bleeding/ lochia and perform the pad measurement

• Assessment of lower legs • Providing breast care • Educating mothers on breast care & breast feeding • Educating mothers on perineal care • Educating mothers on baby care (including umbilical

stump care)

• Educating mothers on family planning& spacing • Educating mothers on nutrition and exercise • Educating mothers on immunization schedule • Educating mothers on milk Formula’s: Types & rationale,

preparation, and sterilization of bottles & teats

Documentation nursing note

54



Management of Patient in Labor: 1. Admission of patient in labor: • Measuring and recording of vital signs • Monitor uterine contraction and fetal heart rate • Assessing contractions • Test urine • Establishing an IV/ collection of blood works

2. Management of patient in labor • Applying CTG machine • Interpreting CTG reading & reporting abnormalities

& providing care as indicated

• Monitoring contraction and fetal heart rate • Use/fill the Portogram • Inserting urinary catheter • Apply pain relief methods (pharmacology &

nonpharmacologic)

• Set up the delivery table • Set up the trolley and instruments for delivery,

episiotomy and suturing.

• Assist with normal vaginal delivery • Assist with episiotomy & repair • Administer the drugs (Syntocinon and Methergine) • Inspection of placenta & collection of cord blood • Prepare patient for emergency Caesarian

Section/Instrumental delivery (forceps /vacuum extraction)

Prepare and Assist with Emergency Interventions and Perform Nursing Management for Patient with:

• Pre-eclampsia and Eclampsia • Hemorrhage (Ante-Natal /Postpartum) • Fetal distress • Diabetic Mother/Gestational diabetes • Abruptio Placenta • Placenta Previa • Ruptured Uterus • Cord Prolapse

55



Provide the Immediate Baby Care

• Suction the baby and clear the airway when needed. - Bulb syringe/nasal suctioning/ oral suctioning

• Measure the Apgar Score • Dry and wrap the baby • Administer of oxygen as indicated • Prepare for and assist with newborn resuscitation. • Provide eye care • Assess/examine the newborn baby • Measure the baby head circumference, weight & height • Inspecting umbilical cord • Collect of blood from umbilical cord • Apply identification of newborn • Fill in the proper documentation

Immediate Postpartum Care of Mother. • Inspect the placental membranes • Assess the uterus and perform uterus massage • Assess Lochia/check for post-partum hemorrhage • Provide the perineal - episiotomy care. • Check criteria for transfer to obstetric unit.

Filling in the birth register and the obstetrical booklet



UNSATISFACTORY

Gynecology Care • Perform Physical Health Assessment • Perform breast examination • Prepare and assist in pelvic examination • Assist in ultrasound • Prepare and assist in vaginal suppositories or cream • Prepare and assist in vaginal packing • Prepare and assist in vaginal pack removal • Prepare and assist in the insertion of IUD • Care of oncology patient (radiation; chemotherapy)

56





UNSATISFACTORY

Provide the Pre-Operative and Post-Operative Care for Patient Undergoing: • Dilatation & Curettage ( Evacuation & Curettage)

• Vaginal operations

• Anterior and posterior repair

• Hysterectomy (abdominal /vaginal)

• Tubal ligation (abdominal & Laparoscopic)

• Laparotomy

• Fistula repair

• Bartholin's cyst & Abscess

• Cervical Cerclage

• Salpingectomy / Oophorectomy

• IUFD (intrauterine fetal death)



UNSATISFACTORY

Provide Nursing Care of Patients with • Hyperemesis Gravidarum

• Ectopic pregnancy

• Pelvic Inflammatory Disease

• Abortions - Threatened - Inevitable - Incomplete - Missed

• Secondary post - partum hemorrhage

• Ovarian cyst

• Hydatidiform mole

• Urinary incontinence

• Gynecology Oncology

57



**VERIFICATION**




STAMP

58



زایتمالا ضیرمت بردتم مییقت جذومن nursing Intern’s Evaluation Form







name

مایألا ددع




Absence with out Excuse اھضیوعت مت يتلا مایألا


Total Days


خیراتلا Date




خیراتلا Date



STAMP

ةجردلا Score

%


%٢٤


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10%


%٩


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دقنلا و حصنلا لوبق Acceptance Of critical evaluation


59



PRAIMARY HEALTH CARE (PHC)

60



PRAIMARY HEALTH CARE (PHC)

Rotation weeks Male 4/w Female 4/w

Objectives of the family and community health center By the end of PHC clinical training, the nurse intern will be able to:

a. Explain the importance of primary health care (PHC) b. Apply health education to client/family according to their needs c. Demonstrate nursing care and health teaching for patient attending clinic with endemic

disease or infectious diseases. d. Practice maternal and child health services care including family planning. e. Apply the principle of evidence-based nursing practice in problem solving and decision

making. For each skill/task performed by intern, the immediate trainer (clinical instructor/preceptor/staff

nurse trainer) will sign (with initials and date) in the appropriate column under the level of performance.



UNSATISFACTORY




UNSATISFACTORY

Antenatal Care. • Measure the mother’s weight and height. • Measures mother vital signs • Perform physical examination. • History taken including obs & gyene history • Preparation for antenatal care "hormone, vitamins,

nutrition and psychological education"

• Screen urine for glucose, ketones, and protein. • Lab. investigation " base line" • Perform Leopold maneuver • Auscultates abdomen to listen to fetal heart sound • Checks the woman fore danger signs of pregnancy • Assess for pitting edema • Administer vaccine " tetanus, measles" • Personal hygiene "breast care"

61



• Nutritional instruction • Gives the woman the necessary instructions & date

of next visit

• Documentation Nursing Note Post Natal Routine Care • History taking • Monitoring vital signs • Perform physical health assessment • Checking level of fundus & lochia • Monitoring pain level • Providing breast care • Health education • Documentation Nursing note

Family Planning • History taking • Health education • Give complete attention to the client • Use simple understandable language • Encourage the client to ask questions • Answer question clearly • Provide complete accurate information about all

options

• Help the client to take decision • Explain the procedure • Use appropriate instructional media in explaining • Explain the warning signs that require immediate

return

• Discuss when the patient needs to return for follow up

• Documentation Nursing note



UNSATISFACTORY

Obtain the pediatric anthropometric measurements • Measures weight and height growth and

development chart

• Measures head, chest, arm, and abdomen circumference

62



• Fill the growth chart and assessing for the normal

growth & development.

• Milestone • Bench measure



UNSATISFACTORY

Vaccination Clinic • Administer IM injection for infants

- Rectus femoris (mid anterior thigh) - Vastus lateralis (middle third thigh)

• Administer IM injection for toddlers and school age (poster dose).

- Posterior gluteal (upper outer quadrant) - Ventro gluteal - Deltoid - Lateral and anterior aspect of the thigh

• Administer intradermal injection • Administer subcutaneous injection • Provide health education to mothers about

vaccination " age, type, name, route, .etc… "

• Provide health education to mothers about normal reaction, and precautions of vaccine and action



UNSATISFACTORY

Dressing Room (First aid Room) • Provide wound care. • Remove the sutures. • Nebulizer administration • O2 therapy • Administration of IV fluids • Oral rehydration therapy

Level of Performance

63



Clinical Skill/Task SATISFACTORY

UNSATISFACTORY

Not Applicable

Chronic Diseases Clinic • Body mass index • History of falls • Special senses examination • Nutritional assessment • Health education "healthy lifestyle, follow up, self-

insulin injection, psychological support"

• Collect urine sample: mid-stream or random • Check blood glucose by using gluco-check machine • Administer oxygen therapy by low devices system:

nasal cannula/ simple face mask

• Administer medications by small volume nebulizer • Administer medications by IM, IV, SC injections

**VERIFICATION**




STAMP

64



زایتمالا ضیرمت بردتم مییقت جذومن nursing Intern’s Evaluation Form






بردتملا مسا Intern’s

name

مایألا ددع




Absence with out Excuse اھضیوعت مت يتلا مایألا


Total Days


خیراتلا Date




خیراتلا Date



STAMP

ةجردلا Score

%


%٢٤


13%

لمعلا و روضحلا يف طابضنالا Punctuality

13%


10%


%٩


%٩


standard

ةجردلا Score

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65



PSYCHIATRY DEPARTMENT

66



PSYCHIATRY DEPARTMENT

Rotation weeks Male 4/w Female 4/w Objectives of the Psychiatry Department Rotation. Upon completion of the training in psychiatry department, the nurse intern will be able to:

• Recognize psychiatric Symptomatology • Apply General principles of psychiatric nursing • Relate with psychiatric patient therapeutically • Communicate with the psychiatric patients effectively • Recognize Legal and ethical aspects of psychiatric care • Set therapeutic limits to the psychiatric patient • Manage psychiatric patients 'Aggression effectively • Engage the patient in suitable Activity therapy • Assist in Electro-convulsive therapy • Apply different psychiatric Treatment modalities • Manage patient with psychotropic medication • Apply nursing care plan for schizophrenic patient • Apply nursing care plan for manic patient • Apply nursing care plan for depressed patient • Utilize the nursing process as an organizational framework to promote care for patients with

health care deviations related to psychiatric disorders • Use of critical thinking strategies and appropriate communication skills in response to

common patient behaviors associated with psychiatric disorders


performance.


Applicable SATISFACTOR

Y UNSATISFACTO

RY

Basic nursing care skills (refer to page 11).



UNSATISFACTORY

Perform the initial nursing assessment • Perform mental status and neurological

examination.

• Perform the suicide risk assessment.

67





UNSATISFACTORY

Use the Therapeutic Approaches: • Behavior therapy (behavior management

techniques)

• Cognitive-behavioral treatment • Dialectical behavior therapy (DBT)

• Hypnosis • Therapeutic limit settings

• Group psychotherapy. • Family therapy

• Individual psychotherapy

• Milieu therapy (use of milieu to enhance patient care and to decrease confusion and tension)

• Impulse control techniques

• Relaxation therapy • Activity and recreation therapy

• Social and vocational training • Patient teaching



UNSATISFACTORY

Use therapeutic communication skills • Use therapeutic verbal communication

• Limits use of non- therapeutic verbal communication

• Use non- verbal communication uses of appropriate gestures and distance for patient personal space.

68





UNSATISFACTORY

Administer and monitor for the following medications: • Controlled medicine (Narcotics) • Antabuse

• Anticonvulsants

• Antidepressants • Antipsychotics

• Benzodiazepines/Anxiolytics • Anti-cholinergic drugs

• Methadone • Mood stabilizers



UNSATISFACTORY

• Attention deficit hyperactivity disorder (ADHD) medications

Prepare and assist in electro-convulsive therapy (ECT) Apply suicidal precautions and manage patient with assaultive behavior

Apply seizure precautions and manage patient with seizures

Manage drug/alcohol detox/withdrawal symptoms

Perform rapid tranquilization as prescribed.

Perform chemical restraints (by drugs) as prescribed

Perform isolation procedures (seclusion) & observation.

Apply and assess the physical restraint: • Ambulatory cuffs • Full restraints. • Wrist restraints

69





UNSATISFACTORY

Care and handles patient with: • Anxiety and anxiety disorders • Schizophrenia

• Mood disorders and suicide • Personality disorders

• Cognitive disorders

• Substance Abuse (alcoholic patient and drug dependent patient)

• Eating disorders

• Somatoform disorders Perform discharge planning

**VERIFICATION**




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name

مایألا ددع






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ةجردلا Score

%


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13%


10%


%٩


%٩


standard



%٧


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