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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
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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: ............................................................
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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
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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.
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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
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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
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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
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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
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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
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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.................................................
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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
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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.................................................
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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: ........................................
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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 ……………………………………..
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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
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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
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........ 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:
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SUGGESTIONS FOR IMPROVEMENT:
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OTHER COMMENTS:
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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........................................................
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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
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