Clinical Log Book BSC Nursing 170622

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MAHARASHTRA UNIVERSITY OF HEALTH

SCIENCES, NASHIK

CLINICAL LOG BOOK


B.Sc. NURSING COURSE

II ययययय यययययययय ययययययय


ययय I यययययय ययययय II
MAHARASHTRA INSTITUTE OF TECHNOLOGY

MAEER College of Nursing


C/o MIMER Medical College & Dr.B.S.T.R. Hospital Campus,
Talegaon Dabhade, Tal. Maval, Dist. Pune-410507
Ph. No.02114-308369, Email [email protected]

CLINICAL LOGBOOK

1
1. Name of the Student :
(In Block letters)

2. Register No. :

3. Age and Sex :

4. Father’s Name :

5. Mother’s Name :

6. Date of joining the course :

7. Date of completion :

8. Local guardian address :

9. Permanent address :

Signature of Principal

Date College Seal

2
GENERAL OBJECTIVE
Students of nursing will develop skills in applying the nursing process in the care of

patients in a variety of clinical settings and they develop the skill of performing

various procedures in the clinical setups, strictly following the related scientific

principles and rationale for the steps followed.

CONTRIBUTORYOBJECTIVES
1. Follow systematically the steps of the procedures.

2. Correlate the knowledge from other disciplines while performing the


steps ofthe procedures.

3. Assemble all articles, required for the procedures.

4. Demonstrate skill in performing the procedures accurately.

5. Develop skill in assessment planning, implementing and


evaluating theNursing care in different set ups, i.e. Hospital and
Community.

6. Assess the learning needs of clients, plan and implement health education

7. Develop the ability to record and report.

3
INSTRUCTION FOR USE OFPROCEDURE RECORD

1. The maintenance of a practical record ensures that the student has received

Instruction on Nursing Procedure and also aids in recording whether the student has

performed the procedure to the satisfaction or not.

2. The practical events must be entered carefully and the record sheet should be marked

after every discussion.

3. All procedures should be demonstrated in the classroom before they are carried out in

the ward.

4. Procedures should be signed by the clinical instructor when the student has performed

the procedure satisfactorily.

5. No student should be allowed to perform the procedure without demonstrating it in

the classroom.

6. Procedures are to be signed after sufficient practice in the clinical area.

7. The student must take responsibility for obtaining a signature from the respective

clinical instructor.

8. Evaluation of student performance should be carried out periodically.

9. A student must complete all the procedures and update the practical record at the end

of each academic year.

4
Clinical Logbook for B.Sc. Nursing
Program(Procedural
Competencies/Skills)
I &II SEMESTER
I. SEMESTER
S. No. Procedural Performs Assists/ DATE Signature of
Competencies/Skills independently Observes theTutor/
Skill Lab/ Clinical
procedures Faculty
Simulation Area
A/O Lab
I Communication and Documentation
1 Maintaining
Communication and
interpersonal
relationship with
patient and families
2 Verbal Report
3 Recording/Documen
tation ofpatient care
(Written Report)
II Monitoring Vital Signs
Temperature
4 Oral
5 Axillary
6 Rectal
7 Tympanic
Pulse
8 Radial
9 Apical
10 Respiration
11 Blood Pressure
III Hot & Cold Application
12 Cold Compress
13 Hot Compress
14 Ice Cap
15 Tepid sponge
IV Health Assessment (Basic–First year level)
16 Health History
17 Physical Assessment–
General & system wise
18 Documentation of
findings
V Infection Control in
ClinicalSettings

5
S. No. Procedural Performs Assists/Ob DATE Signature of the
Competencies/Skills independently serves Tutor/Faculty
Skill Lab/ Clinical
procedures
Simulation Area
A/O Lab
19 Hand hygiene (Hand
washing & Hand rub)
20 Use of personal and
protective
equipment
VI Comfort
21 Open Bed
22 Occupied Bed
23 Post-operative Bed
24 Supine Position
25 Fowler‘s Position
26 Lateral Position
27 Prone Position
28 Semi Prone Position
29 Trendelenburg Position
30 Lithotomy Position
31 Changing Position
of helplesspatient
(Moving/Turning/L
ogrolling)
32 Cardiac table/Over-bed
table
33 Back Rest
34 Bed Cradle
35 Pain Assessment
(Initial&
Reassessment)
VII Safety
36 Side rail
37 Restraint (Physical)
38 Fall risk assessment
& post fall
assessment
VIII Admission & Discharge
39 Admission
40 Discharge
41 Transfer (within
hospital)

6
S. No. Procedural Performs Assists/Ob DATE Signature of the
Competencies/Skills independently serves Tutor/Faculty
procedures Skill Lab/ Clinical
Simulatio Area
A/O n Lab
IX Mobility
42 Ambulation
43 Transferring patient from
& to
Bed & wheelchair
44 Transferring patient
from & tobed &
stretcher
45 Range of Motion
Exercises(ROM)
X Patient Education
46 Individual Patient Teaching

7
II. SEMESTER
S. Procedural Performs Assists/ DATE Signature
No. Competencies/Skills independently Observes Skill Lab/ Clinical of the
procedures Simulation Area Tutor/
A/O Lab Faculty
XI Hygiene
47 Sponge bath/Bed bath
48 Pressure Injury Assessment
49 Back care
50 Care of hand and Feet
51 Skin care and care of
pressurepoints
52 Oral hygiene
53 Hair wash
54 Pediculosis treatment
55 Perineal Care/Meatal care
56 Urinary Catheter care
XII Nursing Process-Basic level
57 Assessment and
formulating nursing
diagnosis
58 Planning the nursing Care
59 Implementation of Care
60 Evaluation of Care
(Reassessment &
Modification)
XIII Nutrition & Fluid Balance
61 24Hours Dietary Recall
62 Planning Well balanced diet
63 Making fluid plan
64 Preparation of
nasogastric tubefeed
65 Nasogastric tube feeding
66 Maintaining intake & output
chart
67 Intravenous Infusion Plan
XIV Elimination
68 Providing Bedpan
69 Providing Urinal
70 Enema
71 Suppositories
72 Bowel Wash

8
S. No. Procedural Performs Assists/ DATE Signature
Competencies/Skills independently Observes of the
procedures/ Skill Lab/ Clinical Tutor/
A/O Simulation Area Faculty
Lab
XV Diagnostic Tests-Specimen collection
73 Urine Specimen for
RoutineAnalysis
74 Urine Specimen for
Culture
75 Time during specimen
collection
76 Feces specimen for
routine
77 Sputum Culture
Urine Testing
78 Sugar
79 Ketone
80 Albumin
81 Reaction
82 Specific Gravity
XVI Oxygenation Needs/Promoting Respiration
83 Deep Breathing &
Coughing Exercises
84 Steam inhalation
85 Oxygen
administration using
facemask
86 Oxygen
administration using
nasal prongs
XVII Medication Administration
87 Oral Medications
88 Calculations of dosage\
strength
89 Intramuscular
90 Subcutaneous
91 Rectal Suppositories
XVIII Death and Dying
92 Death care/Last Office
XIX First Aid and
Emergencies
Bandages & Binders
93 Circular

9
S. No. Procedural Performs Assists/ DATE Signature
Competencies/Skills independently Observes of theTutor/
procedures Skill Lab/ Clinical Faculty
A/O Simulation Area
Lab
94 Spiral
95 Reverse Spiral
96 Recurrent
97 Spica
98 Figure of eight
99 Eye
100 Ear
101 Caplin
102 Jaw
103 Arm Sling
104 Abdominal Binder

105 Basic CPR(first aid


module)

10
CLINICAL REQUIREMENTS

I & II
SEMESTER
Signature of
S. No. Clinical Requirement Date
theFaculty
NURSING FOUNDATION I & II
1 History
Taking –2
1.
2.

2 Physical
Examination –2
1.
2.
3 Fall risk
assessment –21.
2.
4 Pressure Sore Assessment –
21.
2.
5 Nursing Process –
21.
2.

6 Completion of first aid module


7 Completion of Health assessment module

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

11
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

12
Certified by

First semester/Second semester class Teacher

Date: Signature and Seal of Principal

Signature

(Internal Examiner) (External Examiner)

Date: Date:

13
NURSING CARE PLAN

SN Date Topics Signature

Class Coordinator Principal

Practical Examination
Nursing Foundation

1) Signature of Internal Examiner Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner Signature of External


Examiner

Date: Date:

14
III SEMESTER

S. No. Specific Performs Assists/ DATE Signature


Procedural independently Observes of the
Competencies Procedures Skill Clinical Tutor/
/Skills Lab/ Area
A/O Faculty
Simulation
Lab
I MEDICAL

Intravenous therapy

1 IV cannulation

2 IV maintenance &
monitoring
3 Administration of IV
medication
4 Care of patient with
CentralLine

Preparation, assisting, and after care of patients undergoing diagnostic procedures

5 Thoracentesis

6 Abdominal l paracentesis

Respiratory therapies and monitoring

7 Administration of oxygen
using venturi mask

8 Nebulization

9 Chest physiotherapy

10 Postural drainage

11 Oropharyngeal suctioning

12 Care of patient with


chestdrainage
Planning therapeutic diet

13 High protein diet

14 Diabetic diet

15 Performing and monitoring


GRBS
16 Insulin administration

15
S. No. Specific Performs Assists/ DATE Signature
Procedural independently Observes of the
Skill Clinical
Competencies/ Procedures Tutor/
Lab/ Area
Skills A/O Simulation Faculty
Lab
II SURGICAL
17 Pre-Operative care
18 Immediate Post-operative
care
19 Post-operative exercise
20 Pain assessment and
management
Assisting diagnostic procedures and after care of patient sunder going
21 Colonoscopy
22 ERCP
23 Endoscopy
24 Liver Biopsy

25 Nasogastric aspiration
26 Gastrostomy/Jejunostomy
feeds
27 Ileostomy/Colostomy care
28 Surgical dressing
29 Suture removal
30 Surgical soak
31 Sitz bath
32 Care of drain
III CARDIOLOGY
33 Cardiac monitoring

34 Recording and
interpreting ECG
35 Arterial blood gas
analysis–
Interpretation
36 Administration of cardiac
drugs
37 Preparation and after
care ofpatients
undergoing cardiac
Catheterization

16
S. No. Specific Performs Assists/ DATE Signature
Procedural independently Observes of the
Competencies/ Procedures Skill Lab/ Clinical Tutor/
Skills A/O Simulation Area Faculty
Lab
38 Performing BCLS
Collection of blood sample for
39 Blood grouping/cross
matching
40 Blood sugar
41 Serum electrolytes

42 Assisting with blood


transfusion
43 Assisting for bone
marrow aspiration
44 Application of anti
embolism stockings
(TEDhose)
45 Application/maintena
nce ofsequential
Compression
Device
IV DERMATOLOGY
46 Application of topical
medication
47 Intradermal injection-Skin
allergytesting
48 Medicated bath
V COMMUNICABLE
49 Intradermal injection-BCG
and Tuberculin skin Test
or Mantouxtest
50 Barrier nursing & Reverse
barriernursing
51 Standard precautions-
Hand hygiene ,use of PPE,
needlestickand sharp
injury prevention,
Cleaning and disinfection,
Respiratory hygiene,
waste disposal and safe
injection practices
VI MUSCULOSKELETAL
52 Preparation of
patient with
Myelogram/CT/MRI

17
S. No. Specific Procedural Performs Assists/Ob DATE Signature
Competencies/Skills independently serves of the
Skill Clinical
Procedures Tutor/
Lab/ Area
A/O Simulation Faculty
Lab
53 Assisting with
application & removal
of POP/Cast
54 Preparation, assisting
and aftercare of patient
with Skin
traction/skeletal
traction
55 Care of orthotics
56 Muscle strengthening
exercises
57 Crutch walking
58 Rehabilitation
VII OR
59 Position and draping
60 Preparation of operation
table
61 Setup of trolley with
instrument
62 Assisting in major and
minoroperation
63 Disinfection and
sterilization of equipment
64 Scrubbing procedures –
Gowning ,masking and
gloving
65 Intraoperative monitoring

18
III SEMESTER–ADULT HEALTH
NURSING I
Signature
Clinical
S. No. Date of the
requirement
Faculty
Medical

1 Care Study –1

2 Health education–1

3 Clinical presentation/care note–1

Surgical

4 Care study–1

5 Health education–1

6 Clinical Presentation/Care note –1

Cardiac

7 Cardiac assessment –1

8 Drug presentation –1

Communicable

9 Clinical presentation/Care note –1

Musculoskeletal

10 Clinical presentation/Care note –1

OR
Assist as circulatory nurse –
i.
ii.
11
iii.
iv.
V
Assist as scrub nurse in minor surgeries – 5
12
i.
ii.
Iii
Iv
V

19
Signature
S. No. Clinical Requirement Date of the
Faculty
1 Positioning & draping –
3
i.
Ii
Iii
Iv
V
1 Assist as scrub nurse in major surgeries –
4
i.
Ii

Iii

Iv

1 Completion of BCLS module


5

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

20
Certified by

Third semester/class Teacher

Date: Signature and Seal of Principal

Signature

(Internal Examiner) (External Examiner)

Date: Date:

21
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester

Area of Posting Hours

Signature of the Faculty Coordinator College Seal Signature of the HOD/Principal

Practical Examination
Adult Health Nursing - I

1) Signature of Internal Examiner Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner Signature of External Examiner

Date: Date:

22
IV SEMESTER
S. No. Specific Performs Assists/ DATE Signature of
Procedural independently Observes the Tutor/
Skill Clinical
Competencies/ Procedures
Lab/ Area Faculty
Skills A/O
Simulation
Lab
I ENT
1 History taking and
examination of ear,
nose& throat
2 Application of
bandages to
Ear& Nose
3 Tracheostomy care
Preparation of patient, assisting and monitoring of patients undergoing diagnostic procedures
4 Auditory screening
tests
5 Audiometric tests

6 Preparing and
assisting in special
procedures like
Anterior/posterior
nasal packing, Ear
Packing and Syringing
7 Preparation and after
care of patients
undergoing ENT
surgicalprocedures
8 Instillation of
ear/nasal
medication
II EYE

9 History taking and


examination of
eyes and
interpretation
Assisting procedures

10 Visual acuity

11 Fundoscopy,
retinoscopy,
ophthalmoscopy,
tonometry
12 Refraction tests

23
S. No. Specific Procedural Performs Assists/ DATE Signature
Competencies/ Skills independently Observes of the
Procedure Skill Lab/ Clinical Tutor/
Simulation Area
A/O Lab Faculty
13 Pre and postoperative
care of patient
undergoing eye surgery
14 Instillation of
eye
drops/medicat
ion
15 Eye irrigation
16 Application of eye bandage
17 Assisting with foreign
bodyremoval
III NEPHROLOGY&UROLOGY
18 Assessment of kidney and
urinarysystem
 History taking and
physicalexamination
 Assisting with Testicular
self-examination
 Digital rectal exam
Preparation and assisting with diagnostic and therapeutic procedures

19 Cystoscopy,
Cystometrogram
20 Contrast studies–IVP
21 Peritoneal dialysis
22 Hemodialysis
23 Lithotripsy
24 Renal/Prostate Biopsy
25 Specific tests
–Semen analysis,
--Gonorrhea test
26 Urinary Catheterization
&care
27 Bladder irrigation
28 Intake and output
recording andmonitoring
29 Ambulation and exercise

24
S. Specific Procedural Performs Assists/ DATE Signature of
No. Competencies/ Skills independently Observes the Tutor/
Skill Lab/
Procedure
Simulation Clinical Faculty
A/O Lab Area

IV BURNS & RECONSTRUCTIVE


SURGERY
30 Assessment of burns wound
31 First aid of burns
32 Fluid electrolyte
replacement therapy
33 Skin care

34 Care of Burn wounds


o Bathing
o Dressing

35 Pre-operative and post-


operativecare of patient with
burns
36 Caring of skin graft and
post cosmetic surgery
37 Rehabilitation
V NEUROLOGY
38 Neurological
Examination–Use of
Glasgow coma scale
39 Continuous monitoring
thepatients
40 Preparation and assisting
for various invasive and
non- invasive diagnostic
procedures
41 Care of patient
undergoing
neurosurgery including
rehabilitation
VI IMMUNOLOGY
42 History taking and
Physicalexamination
43 Immunological status
assessment and
interpretation of specific
test(e.g. HIV)
44 Care of patient with
low immunity

25
S. No. Specific Procedural Performs Assists/Ob DATE Signature of
Competencies/ Skills independently serves theTutor/
Skill Clinical
Procedures
Lab/ Area Faculty
A/O Simulation
Lab
VII ONCOLOGY

45 History taking & physical


examination of cancer
patients
46 Screening for common
cancers –ex. TNM
classification
Preparation, assisting and after care patients undergoing diagnostic procedures
47 Biopsies/FNAC
48 Bone-marrow aspiration
Preparation of patients and assisting with various modalities of treatment
49 Chemotherapy
50 Radiotherapy
51 Hormonal
therapy/Immun
otherapy
52 Gene therapy/any other
53 Care of patients treated
withnuclear medicine
54 Rehabilitation
VIII EMERGENCY
55 Practicing‘ triage‘
56 Primary and secondary
surveyin emergency
57 Examination,
investigations & their
interpretations, in
emergency & disaster
situations
58 Emergency care of medical
and traumatic injury
patients
59 Documentation, and
assisting in legal
procedures in emergency
unit
60 Managing crowd
61 Counseling
The patient and family in
dealing with grieving
&bereavement

26
IX CRITICALCARE
62 Assessment of
critically illpatients
63 Assisting with arterial
puncture
64 Assisting with ET tube
intubation& extubation
65 ABG analysis and
interpretation
–respiratory acidosis,
respiratoryalkalosis,
metabolic acidosis
,metabolic alkalosis
66 Setting up of ventilator
modesand settings and
care of patient on
ventilator
67 Setting up of trolley with
instrument s/critical
careequipment
68 Monitoring and
maintenance of Chest
drainage system
69 Bag and mask ventilation

70 Assisting with starting


and maintenance of
Central and peripheral
lines invasive
71 Setting up of infusion pump,
and defibrillator
72 Administration of drugs
viainfusion, intra
cardiac, intrathecal,
epidural
73 Monitoring and
maintenance of pacemaker
74 ICU care bundle

75 Management of the dying


patientin the ICU
X Geriatric
76 History taking and
Assessment ofGeriatric
patient
77 Geriatric counseling
78 Comprehensive Health
assessment(adult) after
modulecompletion

27
S. No. Specific Procedural Performs Assists/ DATE Signature of
Competencies/Skills independently Observes theTutor/
Skill Clinical
Procedures
Lab/ Area Faculty
A/O Simulation
Lab
65 ABG analysis and
interpretation
–respiratory acidosis,
respiratoryalkalosis,
metabolic acidosis
,metabolic alkalosis
66 Setting up of ventilator
modesand settings and
care of patient on
ventilator
67 Setting up of trolley with
instrument s/critical
careequipment
68 Monitoring and
maintenance of Chest
drainage system
69 Bag and mask ventilation
70 Assisting with starting
and maintenance of
Central and peripheral
lines invasive
71 Setting up of infusion pump,
and defibrillator
72 Administration of drugs
viainfusion, intra
cardiac, intrathecal,
epidural
73 Monitoring and
maintenance of pacemaker
74 ICU care bundle
75 Management of the dying
patientin the ICU
X Geriatric
76 History taking and
Assessment ofGeriatric
patient
77 Geriatric counseling
78 Comprehensive Health
assessment(adult) after
modulecompletion

28
IV SEMESTER–ADULT HEALTH NURSING II

S. No. Clinical Requirement Date Signature of


the Faculty
ENT
1 ENT assessment of an
adult –i
ii.
2 Observation and activity report of OPD
3 Clinical presentation –1
4 Drug Book
EYE
5 Eye assessment
i. Adult–1
ii. Geriatric–1
6 Patient-teaching–1
7 Clinical Presentation–1
NEPHROLOGY&UROLOGY
8 Assessment of adult –
1AssessmentofGeriatric–
1
9 Drug presentation –1
10 Care study/Clinical presentation–1
BURNSANDRECONSTRUCTIVESURGERY
11 Burn wound assessment – 1
12 Clinical presentation – 1
13 Observation report of Burns unit
14 Observe cosmetic/reconstructive procedures
NEUROLOGY
15 Neuro-
assessment –2I
Ii
1 Unconscious patient – 1
6
1 Care study/case presentation – 1
7
1 Drug presentation – 1
8
IMMUNOLOGY
1 Assessment of immune status
9
2 Teaching of isolation to patient and family care givers
0
2 Nutritional management
1

29
2 Care Note – 1
2

30
S. No. Clinical Dat Signature of
Requirem e the
ent Faculty
ONCOLOGY
2 Observation report of cancer unit
3
2 Assessment of each system cancer patients – 2
4
2 Care study/clinical presentation – 1
5
2 Pre and post-operative care of patient with various
6 modes of cancertreatment such as chemotherapy,
radiation therapy, surgery, BMT, etc.
–3(at least)

i.
Ii
Iii
2 Teaching on BSE to family members
7
EMERGENCY
2 Primary assessment of adult– 1
8
2 Immediate care (IV access establishment, assisting
9 in intubation,suction, etc.)
3 Use of emergency trolley
0
CRITICAL CARE
31 Assessment of critically ill

i. Adult
ii. Geriatric
3 Care note/Clinical presentation – 1
2
GERIATRIC

3 Geriatric assessment – 1
3
3 Care note/clinical presentation – 1
4
3 Fall risk assessment 1
5
3 Functional status assessment – 1
6
3 Completion of Fundamentals of Prescribing module
7
3 Completion of Palliative care module
8

Signature of the Faculty Coordinator Signature of the HOD/Principal

31
College Seal

32
Certified by

Fourth semester/class Teacher

Date: Signature and Seal of Principal

Signature

(Internal Examiner) (External Examiner)

Date: Date:

33
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator College Seal Signature of the HOD/Principal

Practical Examination
Adult Health Nursing - I

1) Signature of Internal Examiner Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner Signature of External Examiner

Date: Date:

34
V &VI SEMESTER –CHILD HEALTH NURSING I &
II
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Skill Lab/ Clinic
Competencies/S ly serves
Simulation al Faculty
kills Procedu
Lab Area
res
A/
O
I PEDIATRICMEDICAL&SURGICAL
Health assessment–Taking history & Physical examination and nutritional assessment of
1 Neonate
2 Infant
3 Toddler
4 Preschooler
5 Schooler
6 Adolescent
Administration of medication/ fluids–Calculation, preparation and administration of
medication
7 Oral
8 I/M
9 I/V
10 Intradermal
11 Subcutaneous

12 Calculation of fluid
requirements
13 Preparation of different
strengths of I/V fluids
14 Administration of IV fluids
15 Application of restraints
Administration of O2 inhalation by different methods
16 Nasal Catheter/Nasal
Prong
17 Mask
18 Oxygen hood

19 Baby bath/sponge bath


20 Feeding children by
Katori &spoon/paladai,
cup
Collection of specimens for common investigations
21 Urine
22 Stool
23 Blood

35
24 Assisting with
common diagnostic
procedures
(Lumbar puncture)
(Bone marrow aspiration)

36
S. No. Specific Performs Assists/ DATE Signatu
Procedural independen Obs reof
Skill Lab/ Clinical
Competencies/S tly erves the
Simulati Area
kills Procedu Tutor/
on
res
Lab Faculty
A/O
Health education to mothers/parents–Topics
2 Prevention and
5 management of
Malnutrition
2 Prevention and
6 management of
diarrhea (Oral
rehydrationtherapy)

2 Feeding &
7 Complementary
feeding
2 Immunization schedule
8
2 Play therapy
9
3 Conduct individual
0 and group play
therapy sessions
3 Prevention of accidents
1
3 Bowel wash
2
3 Administration of
3 suppositories
Care for ostomies:
3 Colostomy Irrigation
4
3 Ureterostomy
5
3 Gastrostomy
6
3 Enterostomy
7

3 Urinary
8 catheterization &
drainage
Feeding
3 Naso-gastric
9
4 Gastrostomy
0
4 Jejunostomy

37
1
Care of surgical wounds
4 Dressing
2
4 Suture removal
3
II PEDIATRIC OPD/IMMUNIZATION ROOM
Growth and Developmental assessment of children
4 Infant
4
4 Toddler
5
4 Preschooler
6
4 Schooler
7
4 Adolescent
8

4 Administration of
9 vaccination
5 Health/Nutritional
0 education

38
S. No. Specific Performs Assists/ DATE Signature
Procedural independen Obs ofthe
Competencies/S tly erves Skill Clinic Tutor/
kills Procedu Lab/ al
Simulati Area Faculty
res
onLab
A/O
III NICU/PICU
51 Assessment of newborn
52 Care of preterm/LBW
newborn
53 Kangaroo care
54 Neonatal resuscitation
55 Assisting in neonatal
diagnosticprocedures
56 Feeding of high risk
newborn –
EBM(spoon/paladai)
57 Insertion/removal/fe
eding–Naso/oro-
gastric tube
58 Administration of
medication–
oral/parenteral
59 Neonatal drug calculation
60 Assisting in exchange
transfusion
61 Organizing different
levels ofneonatal care
62 Care of a child
on
ventilator/CP
AP
63 Endotracheal Suction
64 Chest Physiotherapy
65 Administration of fluids
withinfusion pumps
66 Total Parenteral Nutrition
67 Recording & reporting
68 Cardiopulmonary
Resuscitation–PLS

Signature of the Faculty Coordinator Signature of the HOD/Principal

39
College Seal

40
S. No. Clinical Dat Signature of
Requirem e the
ent Faculty
V & VI SEMESTER –CHIL DHEALTH NURSING I & II
Pediatric medical
1 Nursing care plan–1
2 Case presentation –1
3 Health talk–1
Surgical
4 Nursing care plan–1
5 Case study/presentation–1
OPD/Immunization Room
6 Growth and Developmental study:
i. Infant– 1
ii.
Toddler –
1
iii. Preschooler – 1

iv. Schooler – 1
NICCU/PICU
7 Newborn assessment–1
Newborn assessment–2
8 Nursing Care Plan–1
9 Kangaroo mother care–2
1 Nursing care plan of high risk newborn –1
0
1 Completion of ENBC module
1
1 Completion of FNBC module
2
1 Completion of IMNCI module
3
1 Completion of PLS module
4

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

41
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

42
NURSING CARE PLAN

SN Date Topics Signature


1
2
3
4
5
6

Class Coordinator Principal

Practical Examination

CHILD HEALTHNURSING I & II

1) Signature of Internal Examiner Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner Signature of External Examiner

Date: Date:

43
V & VISEMESTER –MENTAL HEALTH NURSING I &
II
S. No. Specific Performs Assists/ DATE Signature of
Procedural independentl Ob theTutor/
Competencies/S y serves Skill Lab/ Clinic
Simulation al Faculty
kills Procedu
res Lab Area

A/
O
PSCHIATRY OPD
1 History taking
2 Mental status
examination(MSE)
3 Psychometric
assessment(Observe
/practice)
4 Neurological examination
5 Observing &
assisting in
therapies
Individual and group psycho education
6 Mental hygiene
practiceeducation
7 Family psycho-education

CHILD GUIDANCE CLINIC


8 History Taking & mental
statusexamination
9 Psychometric
assessment(Observe
/practice)
10 Observing and
assisting in various
therapies
11 Parental teaching for
child withmental
deficiency
IN-PATIENT WARD
12 History taking
13 Mental status
examination(MSE)
14 Neurological examination
15 Assisting in
psychometric
assessment
16 Recording
therapeutic
communication
17 Administration of

44
medications
18 Assisting in Electro-
convulsiveTherapy (ECT)
19 Participation in all
therapies
20 Preparation of patients
for Activities of Daily
living(ADL)
21 Conducting
admission and
discharge counseling
22 Counseling and teaching
patients and families

45
S. No. Specific Performs Assists/O DATE Signature of
Procedural independent bserves the
Skill Clinic
Competencies/S ly Procedur Tutor/
kills es Lab/ al Faculty
Simulati Area
A/O on
Lab
COMMUNITY PSYCHIATRY & DEADDICTION CENTRE

23 Conducting home
visit and casework
24 Identification of
individuals withmental
health problems
25 Assisting in
organizations ofMental
Health camp
26 Conducting awareness
meetings for mental
health & mental illness
27 Counseling and Teaching
familymembers, patients
and community
28 Observation of deaddiction
care

46
S. No. Clinical Date Signature of
Requirem the
ent Faculty
V&VISEMESTER – MENTAL HEALTHNURSING I& II

Psychiatry OPD
1 History taking and Mental
statusexamination – 2
i.
ii.
2 Health education–1
3 Observation report of OPD
Child guidance clinic
4 Casework –1
Inpatient Ward
5 Case study –1
6 Care plan– 2
7 Clinicalpresentation1
8 Processrecording2
9 Maintain drug book
Community psychiatry & Deaddiction centre
1 Casework –1
0
1 Observation report on field visits
1
1 Visit to deaddiction centre
2

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

47
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

48
NURSING CARE PLAN

SN Date Topics Signature


1
2
3
4
5
6

Class Coordinator Principal

Practical Examination

MENTAL HEALTH NURSING

1) Signature of Internal Examiner Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner Signature of External Examiner

Date: Date:

49
V SEMESTER – COMMUNITY HEALTH NURSING I
INCLUDING ENVIRONMENTAL SCIENCE &
EPIDEMIOLOGY
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Competencies/S ly serves Skill Lab/ Clinic
Simulation al Faculty
kills Procedu
Lab Area
res
A/
O
1 Interviewing skills (using
communication and
interpersonalskills)
2 Conducting community
needs
assessment/survey
3 Observation skills
4 Nutritional assessment
skills
5 Teaching individuals and
familieson nutrition-food
hygiene and safety, healthy
lifestyle and health
promotion
6 BCC (Behaviour
change
communication)skil
ls
7 Health assessment
including nutritional
assessment-differentage
groups
 Children under five
 Adolescent
 Woman
8 Investigating an
epidemic –Community
health survey
9 Performing lab tests –
Hemoglobin, blood sugar,
bloodsmear for malaria,
etc.
10 Screening, diagnosis and
primarymanagement of
common health problems
in the community and
referral of high-risk
clients(Communicable
&NCD)

50
11 Documentation skills
12 Home visit
13 Participation in national
healthprograms
14 Participation i n
schoolhealth
programs

51
V SEMESTER – COMMUNITY HEALTH NURSING –
IINCLUDINGENVIRONMENTALSCIENCE&EPIDEMIOLOGY
S. No. Clinical Requirement Date Signature of
the
Faculty
1 Community needs assessment/survey(Rural/Urban)
–1
2 Visits to -SC/HWC
– PHC
– CHC
3 Observation of nutritional programs anganwadi
4 Observation visits
i. Water purification site and Water quality tests
iii. Milk diary
iv. Slaughter-house
v. Market
vi. Sewage disposal site
vii. Rain water harvesting
viii. Slaughter-house
5 Nutritional assessment–Adult1
6 Individual health teaching –Adult1
7 Use of AV aids – flash cards/posters/flannel
graphs/flip charts (Any Two)
i.
Ii
8 Health assessment of
i. Woman–1
ii. Infant/under five child– 1
iii. Adolescent–1
iv. Adult–1
9 Growth monitoring of children under five –1
1 Documentation
0 i. Individual records– 1
ii. Family records –1
1 Investigation of an epidemic –1
1
1 Screening and primary management of
2
i. Communicable diseases–1
ii. NCD–1
1 Home visits–2
3
1 Participation in national health programs–2
4
1 Participation in school health program–1
5

52
Signature of the Faculty Coordinator Signature of the HOD/Principal

College seal

53
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

54
COMPREHENSIVE FAMILY HEALTH CARE

SN Date Topics Signature


1
2
3
4
5
6

Class Coordinator Principal

Practical Examination

COMMUNITY HEALTH NURSING I

1) Signature of Internal Examiner Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner Signature of External Examiner

Date: Date:

55
VSEMESTER–
EDUCATIONALTECHNOLOGY/NURSINGEDUCATION
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Competencies/S ly serves Skill Lab/ Clinic
Simulation al Faculty
kills Procedu
res Lab Area

A/
O
1 Writing learning outcomes
2 Preparation of lesson plan
3 Practice
Teaching/Microteaching
4 Preparation of
teaching
aids/media
Preparation of assessment
tools
5 Construction of MCQ tests
6 Preparation of
observation checklist

56
V SEMESTER – EDUCATIONAL TECHNOLOGY /NURSING
EDUCATION
S. No. Clinical Date Signature of
Requirement the
Faculty
1 Microteaching –2
i. Theory – 1
ii. Practical/lab– 1
2 Field Visit to nursing educational institution –
regional/nationalorganization

Signature of the Faculty Coordinator Signature of the HOD/Principal

College seal

57
VI SEMESTER–NURSING MANAGEMENT &
LEADERSHIP
Hospital and Nursing Service Department
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Competencies/S ly serves Skill Lab/ Clinic
Simulation al Faculty
kills Procedu
Lab Area
res
A/
O
1 Preparation of
organogram(hospital/
nursing
department)
2 Calculation of
staffing
requirements for a
nursing
unit/ward
3 Formulation of Job
description of nursing
officer (staff nurse)
4 Preparation of Patient
assignmentplan
5 Preparation of duty
roster for staff/students
at different levels
6 Preparation of
logbook/MMF forspecific
equipment/ materials
7 Participation in Inventory
controland daily record
keeping
8 Preparation and
maintenance of records &
reports such as
incident
reports/adverse
reports/audit
reports
9 Participation in
performance
appraisal/evaluation of
nursing staff
1 Participate in
0 conducting in- service
education for the staff
College & Hostel
1 Preparation of
1 organogram ofcollege

58
1 Formulation of job
2 description for tutor
1 Participation in
3 performanceappraisal
of tutor
1 Preparation of Master
4 plan, time-table and
clinical rotation
1 Preparation of student
5 anecdotes
1 Participation in
6 clinicalevaluation
of students
1 Participation in planning
7 and conducting practical
examination OSCE– end of
posting

59
VI SEMESTER–NURSING MANAGEMENT & LEADERSHIP

S. No. Clinical Date Signature of


Requirem the
ent Faculty
1 Field visit to Hospital–regional/national
organization

Signature of the Faculty Coordinator Signature of the HOD/Principal

College seal

Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator Signature of the HOD/Principal

60
College Seal

61
Certified by

Fifth/Sixth semester/class Teacher

Date: Signature and Seal of Principal

Signature

(Internal Examiner) (External Examiner)

Date: Date:

62
VI &VII SEMESTER–MIDWIFERY/OBSTETRICS ANDGYNECOLOGY (OBG) NURSING I & II
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Skill Lab/ Clinic
Competencies/S ly serves
Simulation al Faculty
kills Procedu
res Lab Area

A/
O
I ANTENATAL CARE
Health assessment of antenatal woman
1 History Taking including
obstetrical score,
Calculation ofEDD,
gestational age
2 Physical examination:
head tofoot
3 Obstetrical examination
includingLeopards
maneuvers & auscultation
of Fetal heart sound
(fetoscope/stethoscope/Do
ppler)
Diagnostic tests
4 Urine pregnancy test/card
test
5 Estimation of hemoglobin
usingSahle‘s
hemoglobinometer
6 Advice/assist in
HIV/HBsAg/VDRL
testing
7 Preparation of peripheral
smearfor malaria
8 Urine testing for
albumin and sugar
9 Preparation of mother for
USG
10 Kickchart/DFMC(Daily
Fetaland Maternal
Chart)
11 Preparation and
recording ofCTG/NST

63
12 Antenatal counseling for
each trimester including
birth preparedness and
complicationreadiness
13 Child birth preparation
classesfor
couples/family
14 Administration of Td/TT
15 Prescription of iron &
folic acidand calcium
tablets

64
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Skill Lab/ Clinic
Competencies/S ly serves
Simulation al Faculty
kills Procedu
res Lab Area

A/
O
II INTRANATAL CARE
16 Identification and
assessment of woman in
labour
17 Admission of woman in
labour
18 Performing/assisting CTG
19 Vaginal examination
duringlabour
including Clinical
pelvimetry
20 Plotting and
interpretation of
partograph
21 Preparation for
birthing/delivery
–physical and psychological
22 Setting up of the
birth in
groom/delivery
unit and
newborn corner/care area
23 Pain management
during labour-non-
pharmacological
24 Supporting normal
births/conduct normal
childbirth in upright
positions/evidence based
25 Essential newborn care
26 Basic newborn
resuscitation
27 Management of third
stage oflabour –
Physiologic
management/active
management(AMTSL)
28 Examination of placenta
29 Care during fourth
stage oflabour

65
30 Initiation of breast
feeding and lactation
management
31 Infection prevention
duringlabour and
newborn care
III POSTNATAL CARE
32 Postnatal assessment and
care
33 Perineal/episiotomy care
34 Breast care
35 Postnatal counseling-diet
,exercise & breastfeeding
36 Preparation for discharge

66
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Skill Lab/ Clinic
Competencies/S ly serves
Simulation al Faculty
kills Procedu
res Lab Area

A/
O
IV NEWBORN CARE
37 Assessment of newborn
38 Weighing of newborn
39 Administration of Vitamin
K
40 Neonatal immunization –
Administration of BCG,
HepatitisB vaccine
41 Identification of minor
disordersof newborn and
the management
V CARE OF WOMEN WITH ANTENATAL, INTRANATAL &POSTNATAL COMPLICATIONS
42 High risk assessment
– identification of
antenatal
complications such
as pre-eclampsia,
anemia, GDM
,Antepartum
hemorrhageetc.
43 Post abortion care &
counseling
44 Glucose challenge
test/GlucoseTolerance
test
45 Identification of fetal
distress and its
management
46 Administration of MgSo4
47 Administration of
antenatal corticosteroids
for preterm labour
48 Assisting with Medical
induction of labour
49 Assist in Surgical
induction – stripping and
artificial rupture of
membranes
50 Episiotomy(only if
required) and repair
51 Preparation for
emergency/ele
ctivecaesarean

67
section

52 Assisting in caesarean
section
53 Preparation of mother
and assistin vacuum
delivery
54 Identification and
assisting in management
of malpresentationand
malposition during labour
55 Preparation and assist ing
in low

68
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Skill Lab/ Clinic
Competencies/S ly serves
Simulation al Faculty
kills Procedu
res Lab Area

A/
O
Forceps operation
56 Preparation and
assisting in emergency
obstetric surgeries
57 Prescription/administra
tion of fluids and
electrolytes through
intravenous route
Assisting in procedures
58 Assisting in Manual
removal ofthe placenta
59 Assisting in Bimanual
compression of
uterus/Balloon
tamponade for
atonicuterus
60 Assisting in Aortic
compression for PPH
61 Identification and first aid
management of PPH &
obstetricshock
62 Assisting in
management of
obstetric shock
63 Identification and
assisting in management
of puerperal sepsis and
administration of
antibiotics
64 Management of breast
engorgement and
infections
65 Management of
thrombophlebitis
HIGH RISK NEWBORN (Some aspects of high risk newborn care are included in Child Health
Nursing)
66 Identification of
high-risknewborn
67 Care of neonate under
radiantwarmer
68 Care of neonate on
phototherapy

69
69 Referral and
transportation of high
risk newborn
70 Parental
counseling–sick
neonate and
neonatal loss
FAMILY WELFARE
71 Postpartum Family
planning counseling
72 Postpartum family
planning –Insertion and
removal of
PPIUCD/PAIUCD

70
S. No. Specific Performs Assists/ DATE Signature of
Procedural independentl Ob theTutor/
Competencies/S y serves Skill Lab/ Clinic
Simulation al Faculty
kills Procedu
res Lab Area

A/
O
73 Counseling of the
woman for
Postpartum
sterilization
74 Preparation and
assistingin
tubectomy
OTHER PROCEDURES
75 Preparation and
assisting for
D&C/D&E
operations
76 Observation/Assisting
in Manual Vacuum
Aspiration
77 Assessment of
womenwith
gynaecological
disorders
78 Assisting/performing
Papsmear
79 Performing Visual
inspection of cervix
with acetic acid
80 Assisting/observation
of
cervical
punc
h
biopsy/Cystoscopy/Cryo
surgery
81 Assisting in
gynecological
surgeries
82 Postoperative care of
woman with
gynecological
surgeries
83 Counsel on
Breast self-
examination
84 Counseling
coupleswithin
fertility

71
85 Completion of safe
deliveryapp with
certification

72
VI SEMESTER–MIDWIFERY/OBSTETRICS AND GYNECOLOGY (OBG) NURSING I & II

S. No. Clinical Dat Signature of


Requirem e the
ent Faculty
1 Antenatal assessment and care–20
2 Postnatal assessment and care –15
3 Assessment of labour using partograph–10
4 Per vaginal examination –10
5 Observing normal childbirths/deliveries–10
6 Assisting in conduction of normal childbirth –10
7 Conduction of normal deliveries –10
8 Assisting in abnormal/instrumental deliveries–5
9 Performing placental examination–5
10 Episiotomy and suturing(only if indicated)–3
11 Assist/observe Insertion of PPIUCD–2
12 Newborn assessment–10
13 Newborn resuscitation–5
15 Kangaroo mother care–2
Nursing Care Plan/ Clinical presentation with Drug
Study
16 Antenatal care Normal (care plan) –1
High risk(case study/Clinical presentation)–1
17 Intrapartum care High risk (Clinical presentation) –1
18 Postnatal care
Normal(care
plan) –1
High risk (Clinical presentation) –1
19 Newborn care
Normal (care plan) –1
20 Gynecological condition Care plan – 1
21 Health talk–individual/group–2
22 Counseling mothers and family members
23 Visit to
 Peripheral health facility/Laqshya certified labour
room
 Infertility centre (Virtual/videos)
24 Completion of SBA module
25 Completion of safe delivery app

73
Signature of the Faculty Coordinator Signature of the HOD/Principal
College seal

74
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

75
NURSING CARE PLAN / CASE STUDY

SN Date Topics Signature


1
2
3
4
5
6

Class Coordinator Principal

Practical Examination

MIDWIFERY/OBSTETRICS AND GYNECOLOGY (OBG) NURSING I & II

1) Signature of Internal Examiner Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner Signature of External Examiner

Date: Date:

76
VII SEMESTER–COMMUNITY HEALTH NURSING II
S .No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Competencies/S ly serves Skill Lab/ Clinic
Simulation al Faculty
kills Procedu
Lab Area
res
A/
O
1 Screening, diagnosing,
management and
referral ofclients with
common
conditions/emergenci
es
2 Antenatal and postnatal
care at home and health
centre
3 Conduction of normal
childbirth& newborn care
at health centre
4 Tracking every
pregnancy and filling up
MCP card
5 Maintenance of
records/registers/reports
6 Adolescent counseling
& participation in youth
friendly
Services
7 Counseling for safe
abortion services
8 Family planning counseling
9 Distribution of
temporary
contraceptives –
condoms,
OCP‘s, emergency
contraceptives, Injectable
MPA
10 Insertion of interval IUCD
11 Removal of IUCD
12 Participation in
conducting
vasectomy/tubectomy
camp
13 Screening, diagnosis,
primary management
and referral of clients
with occupational health
problems

77
14 Health assessment of
elderly
15 Mental Health screening
16 Participation in
community diagnosis–
data management
17 Writing health
Centre activity
report
18 Participation in
organizing and
conducting clinic/health
camp
19 Participation in disaster
mockdrills
20 Co-coordinating with
ASHAs and other
community health
workers

Signature of the Faculty Coordinator Signature of the HOD/Principal


College seal

78
VI SEMESTER–COMMUNITY HEALTH NURSING II

S. No. Clinical Dat Signature of


Requirem e the
ent Faculty
1 Screening and primary management of
I. Minor ailments-2
II. Emergencies-1
III. Dental problems-1
IV. Eye-1
V. ENT-1
2 Primary management and care based on protocols
approved by MOH& FW (Home/Health centre)
3 Screening and primary
management ofI High risk
pregnancy
High risk neonate
4 Assessment of
i. Antenatal-1
ii. Intrapartum-1
iii. Postnatal-1
iv. Newborn-1
5 Conduction of normal childbirth and documentation – 2
6 Immediate newborn care and documentation – 1
7 Family planning counseling – 1
8 Group health education (Rural/urban) – 1
9 Adolescent counseling– 1
10 Family case study (Rural/urban) – 1
11 Screening, diagnosis, primary management and
referral of clients withoccupational health problems –
2
i.
ii.
12 Health assessment (physical & nutritional) of elderly – 1
13 Mental health screening survey – 1
14 Group project – Community diagnosis (data
management)
15 Writing report on health centre activity – 1
16 Participation in organizing and conducting
under five/antenatalclinic/health camp – 2 i. ii.
17 Participation in disaster mock drills

79
18 Field visits
- Biomedical waste management site

- AYUSH centre

- Industry
- Geriatric home
19 Report on interaction with
MPHW/HV/ASHA/AWWs (Any 2) 1.
2.

80
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

COMPREHENSIVE FAMILY HEALTHCARE

SN Date Topics Signature


1
2
3
4
5
6

Class Coordinator Principal

81
Practical Examination

COMMUNITYHEALTHNURSINGII

1) Signature of Internal Examiner Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner Signature of External Examiner

Date: Date:

82
S. No. Specific Performs Assists/ DATE Signature of
Procedural independent Ob theTutor/
Skill Lab/ Clinic
Competencies/S ly serves
Faculty
kills Procedu Simulation al
Lab Area
res
A/
O

VII SEMESTER–NURSING RESEARCH &


STATISTICS
Research Process Exercise
1 Statement of the problem
2 Formulation of
Objectives &
Hypotheses
3 Literature review of
researchreport/article
4 Annotated bibliography
5 Preparation of sample
researchtool
Analysis & Interpretation of data –Descriptive statistics
6 Organization of data
7 Tabulation of data

8 Graphic representation of
data
9 Tabular presentation of data
10 Research
Project(Group/I
ndividual)
Title:

Signature of the Faculty Coordinator Signature of the HOD/Principal

College seal

83
VIII SEMESTER
(INTERNSHIP)

CLINICAL EXPERIENCE DETAILS

Name of ICU Clinical Condition Number of days Signature of


caregiven Faculty/Precept
or

Signature of the Faculty Coordinator Signature of the HOD/Principal

College seal

84
Clinical Posting the Basic B.Sc. Nursing Students

Month Semester
Area of Posting Hours

Signature of the Faculty Coordinator Signature of the HOD/Principal

College Seal

85
Certified by

Seventh semester/class Teacher

Date: Signature and Seal of Principal

Signature

(Internal Examiner)(External Examiner)

Date: Date:

86
Competency Exam

1) Signature of Internal Examiner 1. Signature of External Examiner

Date: Date:

2) Signature of Internal Examiner 2. Signature of External Examiner

Date: Date:

3) Signature of Internal Examiner

Date:

87

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