ISBN 978- 9987-02-004-1

TANZANIA NURSING AND MIDWIFERY COUNCIL

CLINICAL PRACTISE GUIDELINE FORBSc NURSE INTERN

Revised, 2014

RegistrarTanzania Nursing and Midwifery CouncilP. O. Box 6632Dar es Salaam

2

TANZANIA NURSING AND MIDWIFERY COUNCILBSc NURSE INTERN CLINICAL PRACTISE GUIDELINE

Full Name: (in capital letter).................................................................................................................................First Middle Last/family

Other Names (If any): ...............................................................................................(In Capital Letters)

Date of Birth:............................. Place of Birth: ............................ Nationality: ....................(Date – Month - Year)

Academic Qualification(s): .......................................

Year Completed: ....................................

Name of Institution...................................................................................................................

Provisional Nursing Registration No:................................................................................................

Name of Hospital Offering Internship: .....................................................................................

Internship Commencement Date: ...........................................................................................

Internship Completion Date: ..................................................................................................

Signature: ................................................ Date: ............................................................

3

Table of Content

Introduction.......................................................................................................... 4

Regulations........................................................................................................... 5

Intern Nurse Responsibilities............................................................................... 5

MoH&SW Roles................................................................................................. 5

Institutional Roles.............................................................................................. 7

Clinical Guidelines............................................................................................ 8

Notes................................................................................................................. 18

Summary of clinical Placement………………………………………….…......... 23

4

Introduction

In Tanzania, undergraduate nurse students who completed four years of their studies in arecognized university are required to undertake a one year internship before they can befully registered in the TNMC register as per section 17 of the Nursing and Midwifery Act,2010.

Since the establishment of the BScN in Tanzania in 1989, TNMC has been receivingundergraduate nurses who were posted to referral hospitals for the nursing practicalexperiences. The hospital receives and supervises intern nurses in accordance with theprotocols existing in that hospital.

The purpose of TNMC internship guidelines is to provide universal standards that will beused by institutions offering opportunities for nurses to do internship. Requirementsprescribed in this document will enable nurses under provisional registration status to gaincompetences on nursing protocols under the supervision of mentors or competent nurseswho will train, evaluate then building their capacity to function autonomously as competentnurse practitioners.

5

PART ONE: REGULATION AND GUIDELINES

Regulations

Internship is mandatory for all undergraduate nurse students for eligibility of fullregistration as per section 17 (1), (2) and (3) of The Nursing and Midwifery Act. No.1 of2010. The internship will be of one year duration undertaken at the health institutionapproved by the TNMC

The intern nurse shall rotate in various departments for a period of not less than four –eight weeks in each department or as shall be deemed by the council. Departmentsreferred to here include: medical, surgical, obstetrics and gynaecology, intensive care(ICU), operating theatre, paediatrics, OPD and emergency department, leadership andmanagement, teaching, and mental health.

Clinical rotation will not be counted as complete if the intern has not fully participated inall nursing shifts where appropriate

A person shall not commence an internship unless he/she has been provided with aprovisional registration.

The hosting Institution shall not employ or treat an intern nurse as fully qualified nurse. The intern nurse will be paid by the government a monthly allowance as stipulated in the

government regulations The person shall start internship on time and complete uninterrupted unless there are

strong reasons approved by the council. Any intern nurse who interrupts his/her training shall have to reapply for another

intership to the Registrar Intern nurse must wear a prescribed uniform by TNMC. Interns are not allowed to strike or organize extended meetings at their practicum site

without consent of the institution.Internship shall be regarded as complete upon successful completion of the required periodof 12 months of internship, submission of appropriate documents and on payment of theprescribed fees to the Registrar.

Intern nurse responsibilities Report to the institution on the agreed upon date. Attend induction course with other interns, and arrange to meet supervisors at each

rotation in order to have a dialogue on how both are going to work. Adhere to clinical schedule including time to report on duty and off duty each day. Report to the supervisor if unable to attend because of illness or other emergency

situations, as soon as possible. Practice under supervision and maintain professional behaviour and standards of

practice as delineated in the professional code of conduct. Adhere to policies of the host hospital and procedures and should seek clarification from

relevant authorities. Participate in periodic professional conferences, meetings and other activities to share

information and update personal understanding Establish and maintain team work spirit with supervisors and other co-workers Perform and assist the department in any other duties that may arise from time to time,

and become creative in quality improvement strategies

6

Participate in preparation of the final report with the supervisor Adopt evidence based practice and initiate changes in clinical settings

Ministry of Health and Social Welfare Roles The Ministry of Health and Social Welfare and office of registrar shall receive names of

graduates from training institutions upon completion of undergraduate studies The Chief Nursing Officer shall allocate the interns in the approved hospitals/health

institutions for practical experiences and inform the MoHSW about the number togetherwith names of intern nurses allocated

The Registrar will provide to each intern nurse a provisional registration and leavehim/her under close supervision of Supervisory Authorities

The Registrar will provide to each intern nurse with the following documents; guidelines,regulations and clinical rotation assessment booklet. The host institution will recievecopies of the same.

The host institutions shall submit progress reports at least twice a year excluding thefinal report prepared and submited upon completion.

The host institution shall submit to the Registrar certificates of completion to enableprocessing of full registration of the succesful interns.

Roles of the Institutional

Identify and assign a senior experienced registered nurse (Mentor) to oversee intern’spractice.

Inform the MoHSW and CNO regarding the post for interns available for each year Communicate with relevant authorities regarding when internship starts and ends; and

must as much as possible refrain from allowing interruption in between e.g. permissionto postpone

Conduct an orientation for all interns about the hospital policies and procedures; andhow they are expected to behave during the whole time of their internship.

Enter into contract with intern students in accordance with expectations of both parties Provide identity cards to intern nurses and allow access to other services such as

library, Information Technology (IT), conferences and professional meetings. Provide schedule of clinical rotation and make necessary arrangements for and keep

necessary records of intern nurses Provide other necessary services e.g. medical care, meals, accommodation, transport,

extra duty allowances as may deem necessary and in accordance with institutionalpolicy

Arrange regular meetings for all interns to hear their concerns and provide guidance Submit to the registrar all final reports and assessment forms of each intern nurse within

14 days after the completion of internship.

ISBN 978- 9987-02-004-1

PART TWO – CLINICAL GUIDELINEPUT (√) WHERE APPROPRIATE IN THE LEVEL OF EXPERIENCE ACQUIRED

Placement Experience Expected to beAcquired

Level of ExperienceAcquired

InternsSignature

Mentors

A B C D E FComments Signature

MEDICALNURSING

Duration – 8weeks

Commencementdate.......................

Finishingdate.......................

Admission of Patient

History taking Taking vital signs Perform Physical

examination(Use inspection, auscultation,palpation, percussion) Neurological examination Proper

Documentation/recording Develop nursing care plan

General patients’ care Provide holistic careo General body Cleanliness

oral hygiene bed bath hair eyes and feet

o Nutrition needso Elimination needso Psychological and

spiritual care of patientand relatives

o Medicationo Care of chronic illness

2

o Care of paralyzedpatients

o Care of the critically illpatient

o Care of the dying patiento Care of pressure areas

Collect Laboratoryinvestigations Blood Sputum Urine Stool Specimen collection tools

for c/s

Assist patient ininvestigations

o X-rayo Lumber punctureo Abdominal paracentesiso Chest aspirationo Ultrasoundo Bone marrow aspirationo Biopsyo E.E.Go E.C.Go CT Scano MRIo ECHO

Medicines management/logistics

3

Ordering Recording Storing Issuing Adherence to FIFO and

FEFO procedures Adherence to Dangerous

Drugs Act (DDA)

Administrations ofMedicines and fluids Preparation of equipment

and administration ofo Oral medicationo i/v medicationo i/v fluidso i/m injectionso ear/nose/eye

medicationso Topical medicine

applications Safe blood transfusion

Maintaining respiratoryintegrity Administering oxygeno By face masko By nasal catheter

Suctioningo Oropharyngealo Tracheobrochial

4

o Endotracheal Performing chest percussion Teach patient breathing

techniques (deepbreathing, naturalexhalation, and coughing)

Infections Prevention andControl Hand washing and scrubbing

:before and after procedure Sterile gloving, gowning and

masking Preparation of sterile

equipment Use of safety boxes Decontamination of

equipment

Making Different Types ofBeds Cardiac bed Occupied bed Un occupied bed Pre and Post operating

beds

Documentation andReporting Writing Report Giving verbal and written

5

report to other health careproviders

Implementing the IT nursingmodule effectively (e.g.JEEVA, care 2x)

Utilizing documentedinformation to improve care.

Keeping Patient’s records

Discharging Patients Discharging the patient Giving appropriate

information on:- Health education related

to his/her condition- Drugs to be used

Date of return for check upSupervisor’ Name: .............................

Signature: ........................................

Date.................................................

6

Placement Experience Expected To BeAcquired

Level of ExperienceAcquired Supervisor’s

CommentsIntern’sSignature

DateA B C D E F

SURGERY

Duration - 4Weeks

Commencementdate.....................

Finishingdate....................

Preparation of Patients forOperation Pre operative care Preparing different types of

bedsOthers specify

Post-Operative Care of Patientwitho Laparatomyo Thyroidectomyo Colostomyo Tonsillectomyo Tracheostomyo Under water seal drainageo Thoracotomyo Amputationo Transurethral resection of

prostateo Laminactomy,o Skin graftingo Others Specify

7

Care of patients withdifferent orthopaedicconditions:o Skin tractiono Skeletal tractiono P.O.Po External Fixator

Postural drainage andcapping

Assisting with endoscopes

Supervisor’ Name: .............................Signature: ........................................

Date.................................................

8

Placement Experience Expected To BeAcquired

Level of ExperienceAcquired

SupervisorsComments

Intern’sSignature Date

A B C D E F

PAEDIATRICNURSING

Duration - 4weeks

Commencementdate.....................

Finishingdate.....................

Apply relevant updates toprovide Holistic Nursing Careto; Infants Toddlers Older children up to 10 yrs Pre-schoolers Acute illness and Chronic

illness Play stimulationAdministration of; Intravenous fluids Intra venous drugs Insertion of Nasogastric tube Insertion of scalp vain Meeting psychological and

spiritual needs ofparents/guardian

Supervisor’ Name: .............................

Signature: ........................................

9

Date.................................................

Placement Experience Expected ToBe Acquired

Level of ExperienceAcquired

Internsignature

Mentor

A B C D E F comments signatureReproduction and childHealth (RCH) Obstetriccare and care of patientswith gynaecologicalproblems

Duration - 12 weeks

Commencementdate.........................

Finishingdate............................

Organize and Manage thefollowing services:Antenatal ServicesManage pregnant MothersTake Observation to include Vital sign- Blood

pressure P, R & T Weight Height

Take Full appropriatehistory Personal Family Medical Social Obstetric

Carry out systematicphysical examinationand Foetal monitoring -FHR

Carry out appropriateinvestigations

10

Blood Urine

Health education andCounselling on Hygiene Diet Rest Preparation for Labour,

Lactation and others Prescribe/Provide

appropriate drugs Complete all health

records

Care During LabourPerform assessment Pregnant woman in

labour Foetal monitoring – FHR

First stageUse partograph to identifyclients prognosis-Foetal heart rate-Descent-Contractions-Per vaginal examination

at least five mothers-Cervical dilatations-Blood pressure

11

Second Stage-Conducting deliveries-Normal deliveries (at

least ten)-Abnormal deliveries (at

least five)-Performing episiotomy

and repair if indicated-Repair of perinea tear

Care in Third stage oflabour Active Management of

3rd stage of labour Measure blood loss Identify early signs of

PostpartumHaemorrhage

Examine the placenta Recognize at risk

mothers for FurtherManagement andprioritize care

Prescribe/provideappropriate drugs

Assist to manageabnormal labour Multiple pregnancy Malpresentation e.g.

12

Breech, Bad Obstetric History

(BOH) Previous Caesarean

Section Others

Care during pueperium Take Full appropriate

history (peuperium) Carry out systematic

physical examinationduring peuperium

Provide PMCTC servicesto clients and patients

Health education onpersonal care and care ofthe baby

Care of New born baby Perform assessment

(APGAR Scoring) Resuscitation of a new

born baby Weighing Nursing care

Manage babies withfollowing diagnosis Asphyxia neonatorum Baby of a diabetic

13

Mother Low birth weight Congenital

Malformations HIV exposed infant Others (specify)

.......................................

Child Health andunder fives Management Take weight and

observation Take History from

mother Perform systematic

physical examination Health

education/Counsellingono Nutritiono Immunizations

Growth Monitoring

Administer vaccines asper schedule: BCG Polio Vaccine, DPT Measles and others Penta valent vaccineCold Chain Maintenance Work with cold chain

14

coordinator for at least 2dayso To be acquainted

with storageo Chartingo Data managemento Participate in

ordering ofimmunizationsupplies

Management of HIVexposed Children

Competence of ARTadolescents counselling

Family Planning ServicesManage clients attendingclinic Take Observation Weight Vital signs-Blood

pressure Take History

Counsel for informedchoice for all methodsEnsure Infection PreventionPerform systematic physicalexamination includingdemonstration on selfbreast examinationPerform pelvicexamination including

15

Speculum Examination Cervical cancer

screening Bimanual ExaminationAssist insertion andadministration ofo Pillso Injectableso IUCDs

Supervisor’s Name..........................

Signature…………………………..

Date………………………………..

Placement Experience Expected To BeAcquired

Level of ExperienceAcquired Supervisors

CommentsIntern’sSignature

DateA B C D E F

Leadership andManagement

Duration 6 weeksCommencementdate................Finishingdate................

Leadership Skills Administrative Duties Receive night summary report of

patients and hospital events Attend staff with problems Attend nurse Managers’ meetings Arrange duty roster for nurse

Managers and supervisors

16

Attend to clients/relativescomplaints

Organizing and conductingmeetings, education sessions andprofessional developmentactivities

Budgeting and management ofstores and supplies.

Ward Management andSupervision Providing supportive supervision in

the wards. Advising on nursing care planning Advising on documentation and

record keeping Advising on care of unconscious

patients, bedridden patients andpatients with special care

Checking staff punctualityallocation and professionalism

Demonstrate knowledge of healthpolicy, legislation and regulationsrelevant to nursing practice

Manage the complexities arisingfrom ethical issues and legaldilemmas.

Teaching and supervising students

17

in the wards Orient with Work place

intervention on HIV /AIDSincluding PEP policy

Supervisor’s Name.....................................

Signature…………………………………

Date………………………………………

Placement Experience Expected To BeAcquired

Level of ExperienceAcquired Supervisors

CommentsIntern’sSignature

DateA B C D E F

TheatreTechniques(4 Weeks)Commencementdate......................

Finishingdate......................

Preparation of operating theatre Processing instruments and

equipment Preparing packs/tray/set Preparation to assist operations

- Scrubbing- Wearing sterile gown- Management of theatre table

Assisting operation as Scrub nurse Circulating nurse/runner

Care of Patients in Recovery Room Assessment

18

Checking vital signs Document and report

Administration and Management ofOperating Theatre

Intensive CareUnit(6 Weeks)Commencementdate......................

Finishingdate.....................

Familiarization to and use ofVarious Facilities such as Ventilator, Monitor, Defibrillator, Infusion pumpsTaking care of critically ill patients

Supervisor’s Name...................................

Signature………………………….……..

Date ……………………………………..

19

Placement Experience Expected To BeAcquired

Level of ExperienceAcquired Intern’s

SignatureMentors

A B C D E F

Comments SignatureMental Health Nursing(4 Weeks)Commencementdate.........................

Finishingdate....................................

Admission of patients withvarious categories

Conduct mental healthassessment

Observation and attendingpatients who are;o Substance abuseo Aggressiveo Talkativeo Mute

Administration of drugs Plan and carry out nursing

care intervention to patientsthrough;o Physiotherapyo Occupational therapyo Group therapyo E.C.To Recreational activitieso Counselling

Follow up care anddischarged patients in OPD

20

clinic and rehabilitationcentres

Organize and conduct oneconference on given case andupdates in psychiatricconditions including homevisiting, family planningeducation of client

Manage patient in emergencyo Abscondedo Suicidal tendencyo Aggression

Supervisor’s Name...................................Signature………………………….……..Date ……………………………………..

Placement Experience Expected To Be Acquired

Level of ExperienceAcquired

Intern’sSignature Mentor

A B C D E FComments Signature

Teaching(8 Weeks)Commencementdate.........................

Finishingdate............................

Teaching students in class andclinical areas Preparing teaching plan Preparing assessment plan Prepar ing lesson plan Preparing lecture notes Uses of different teaching

methodologies and teaching aids

21

........ Preparing teaching materials forclassroom and clinical teachingsession

Preparing and using of educationalassessment tool in all levels ofunderstanding

Conduct demonstrations Conduct clinical teaching Handing students’ assessment

report to supervisor Counselling students with personal

problems Demonstrating role model

characteristics

Supervisor’s Name...................................

Signature………………………….……..

Date ……………………………………..Note:

Level of experience descriptions

A – ExcellentB – Very goodC – GoodD – SatisfactoryE – PoorN – Not Applicable

ISBN 978- 9987-02-004-1

NOTES ON VARIOUS OBSERVATIONS:

............................................................................................................................. ....................

............................................................................................................................. .....................

..................................................................................................................................................

............................................................................................................................. .....................

..................................................................................................................................................

............................................................................................................................. .....................

..................................................................................................................................................

............................................................................................................................. .....................

............................................................................................................................. .....................

..................................................................................................................................................

SUGGESTIONS FOR IMPROVEMENT:

............................................................................................................................. .....................

..................................................................................................................................................

............................................................................................................................. .....................

............................................................................................................................. .....................

..................................................................................................................................................

............................................................................................................................. .....................

............................................................................................................................................

............................................................................................................................. ................

OTHER COMMENTS:

................................................................................................................................................

............................................................................................................................. ...............

............................................................................................................................. .................

............................................................................................................................................

............................................................................................................................. ...............

2

SUMMARY

Total Period of Internship (in Weeks)....................................................................... 52

S/N EXPERIENCE TO BE ACQUIRED RECOMMENDEDNO OF WEEKS

ACTUAL WEEKSOF EXPERIENCE

1 Medical- Nursing 42 Surgical Nursing 43 Paediatric Nursing 44 Proficiency in Reproduction and

Child Health. Maternal and child health

clinics including FamilyPlanning

4

Labour wards 4 Post natal and neonatal

wards4

Gynaecological ward 25 Leadership and Management

Hospital Supervision 2 Ward Management and

Supervision4

6 Operating Theatre Techniques 47 Mental Health Unit 48 Intensive care Unit 49 Teaching 410 Annual leave 4

3

FINAL APPROVAL

Supervisor/Senior nurse manager

I certify that the above-mentioned Intern has successfully undergone one-year practicalplacement as requirement for full registration.

Full Name...............................................................................................................................

Title ………………………………………

Signature.................................................................Date........................................................

Supervisory Authority (DNS, RNO, DNO)

Full Name.................................................................................................................... .............

Title ……………………………………….

Signature.................................................................Date........................................................

4

CRITERIA FOR HEALTH FACILITY APPROVED FOR INTERNSHIP PRACTICE

The institution should be a Consultant, Specialized, Regional referral and Hospital atregional level hospitals

The institution should have the following departments: Medical, Surgical, Obs & Gyn,Paediatrics, Mental health, ICU, Theatre, Special clinics (ENT, RCH, CTC) Emergencydepartment and Administration

Institution should have at least 2 nurse specialists and 1 BScN nurse at eachdepartment needed for internship

Availability of accommodation for interns

Availability of a resource centre with adequate reference materials