Internship Log-Book For the Bachelor Nursing Program.

1

وزارة التـعـــلـــيـم

ةـــــة طيبــامعــــجضـريـمـالت ةـــكلي

زاــدة الامتيـــوح

Kingdom of Saudi Arabia

Ministry of Education

Taibah University

College of Nursing

Internship Unit

(الامتياز)الإلزامي لتدريبا كتيب

(لبرنامج بكالوريوس التمريض )انتظام

Internship Log-Book

For the Bachelor Nursing Program.

First Edition - 1437 H (2016 G)

Name of Nurse Intern ………………………………………………………..

Date Started (from) ………………… Date completes (To) ……………

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Taibah University

College of Nursing

Internship Unit

Prepared by:

Dr. Khaled Mohammed Al-Sayaghi

Associate Professor of Critical Care and Emergency Nursing

Supervisor of the Internship Unit.

Reviewed by:

Mr. Abdullah Alhujaili Dr. Mohammed S. Aljohani

Lecturer of Medical Surgical Nursing Assistant Professor of Emergency Nursing

Vice Dean for Academic Affairs Head of the Medical Surgical Department

Approved by:

Dr. Omar M. Al Nozha

Assistant Professor of Medicine & Consultant Endocrinologist

Dean of the College of the Nursing

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Taibah University

College of Nursing

Internship Unit

CONTENTS

Item Page No

Personal details of nurse intern 4

List of abbreviations 5

Rotations achieved by the nurse intern 6

Introduction 7

Objectives of the internship program. 7

Purpose of the log book 7

Internship training period 8

Internship clinical area rotation (time distribution) 8

Instructions for the clinical instructor’s 8

Example for signatures in the log book 10

Attendance record form 11

Clinical skills for:

Clinical skills for the Basic Nursing Care 12

Clinical Skills for Medical Department. 13

Clinical Skills for Dialysis Unit 16

Clinical Skills for Surgical Department. 19

Clinical Skills for Operation Room. 23

Clinical Skills for Emergency Department. 25

Clinical Skills for Intensive Care Unit. 28

Clinical Skills for Pediatric Department 31

Clinical Skills for Maternity and Obstetric Department. 34

Clinical Skills for Labour Room. 37

Gynecology Department. 40

Clinical Skills for Primary Health Care Center. 42

Clinical Skills for Psychiatry Department. 44

Nursing Administration. 47

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Taibah University

College of Nursing

Internship Unit

Personal Details of the Nurse Intern

Name: __________________________________________

National ID number: _________________

University Number: _________________________________

Date of Joining in the Program: _________________________________

Date of Completion of Bachelor Requirements: _________________________

Permanent Address: ___________________________________________

__________________________________________________________

Present Address: ________________________________________________

___________________________________________________________

Phone Number:_____________________________________

Mobile Number:____________________________________

E-mail Address: ____________________________________

Signature of the Nurse Intern

Passport Size

Photo

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Taibah University

College of Nursing

Internship Unit

List of Abbreviations

ABCDE Airway, Breathing, Circulation, Disability, and Exposure,

ADHD Attention Deficit Hyperactivity Disorder

AV Graft Arteriovenous Graft

ACLS Advanced Cardiac Life Support

BP Blood Pressure

BLS Basic Life Support

CRRT Continuous Renal Replacement Therapy

CS Caesarean Section

CTG Cardiotocography

CT scan Computed Tomography Scan

CVC Central Venous Catheter

CVP Central Venous Pressure

DBT Dialectical Behavior Therapy

ECG Electrocardiography

ECT Electro-Convulsive Therapy

ED Emergency Department

ERCP Endoscopic Retrograde Cholangiopancreatography

ETT Endotracheal Tube

ESWL Extracorporeal Shock Wave Lithotripsy

GCS Glasgow Coma Scale

GI Gastrointestinal

GIT Gastrointestinal Tract

HEENT Head, Eyes, Ear, Nose and Throat.

HD Hemodialysis

HME Heat and Moisture Exchanger

Per OS By Mouth

ICP Intracranial Pressure

ICU Intensive Care Unit

IM Intramuscular

IUD Intrauterine device

IV Intravenous

IVP Intravenous Pyelogram

MRI Magnetic Resonance Imaging

NGT Nasogastric Tube

NST Non-Stress Test.

OB Obstetric

OPD Out Patient Department

ORS Oral Rehydration Fluid

OR Operation Room

PA catheter Pulmonary Artery Catheter

PPE Personal Protective Equipment

PPN Peripheral Parenteral Nutrition

SC Subcutaneous

TPN Total Parenteral Nutrition

http://www.baxter.com/products-expertise/renal-failure-treatments/expertise/crrt.page

https://en.wikipedia.org/wiki/Heat_and_moisture_exchanger

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Taibah University

College of Nursing

Internship Unit

Rotations Achieved by the Nurse Intern

Sl. No Name of Rotation Period

Duration Hospital From To

Medical Department …..weeks

Hemodialysis Unit …..weeks

Surgical Department …..weeks

Operation Room (OR) …..weeks

Emergency Department (ER) …..weeks

Intensive Care Unit …..weeks

Pediatric Department …..weeks

Obstetric & Gynecology

Department …..weeks

Primary Health Care Center …..weeks

Department of Psychiatry and

Mental Health. …..weeks

Nursing Administration …..weeks

……………………………………

…….. (Elective) …..weeks

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Taibah University

College of Nursing

Internship Unit

Introduction.

The internship program is a prerequisite for the terms of the Ministry of Education in

Saudi Arabia for the bachelor's degree in nursing and a prerequisite for the terms of the

Saudi Commission for Health Specialties in Saudi Arabia to obtain a license to practice the

nursing profession in the Kingdom. Internship field experience gives the student an

opportunity for training in the different departments which helps to gain practical

experiences. It also gives the opportunity for actual application of all that have been learned

during the study years in the college. By successful completion of this internship period the

graduate is expected to fulfill the objectives of the program and will be awarded the

certificate.

This logbook is designed to provide a guideline for nurse intern during the internship

program. The logbook includes a list of major skills/procedures to ensure the achievement

of clinical objectives of each specific unit rotation. Each specific procedure checklist differs

from one hospital to another thus refer to policy & procedure for details.

The log book is kept by the nurse intern. After completion of skill/task, it is the

responsibility of nurse intern to take the signature from immediate staff nurse trainer

(clinical instructor). The log book must submitted by nurse intern to the internship unit at

the end of the internship.

General Objectives for the Internship Program:

The program aims to:

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

clinical setting.

2. Improve and refine the nurse intern communication skill and professional relationships

with patients and members of the multidisciplinary health care providers.

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

providing professional nursing care.

4. Acquaint the nurse intern with various hospital policies and procedures.

5. Help the nurse intern to develop the necessary skills and competencies that make

him/her safe practitioners.

Purpose of the Log-Book:

1. To emphasize major competencies and clinical skills in each unit rotation.

2. To assist in the follow up / progress of nurse intern throughout internship program.

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Taibah University

College of Nursing

Internship Unit

Internship Training Period.

All interns in bachelor nursing program are expected to work 40 hours a week in a

total of 52 weeks.

Internship Clinical Rotations (Time Distribution) for the Bachelor's Program.

Main Departments Number

of Weeks Specific Areas

Number

of Weeks

Medical Department 8 Medical Department 6

Hemodialysis (HD) Unit 2

Surgical Department 8 Surgical Department 6

Operation Room (OR) 2

Emergency Department (ED) 4 ED 4

Intensive Care Unit (ICU) 6 ICU 6

Nursing Administration 2 Nursing Administration 2

Psychiatric Department 4 Inpatient 2

Emergency Room 2

Primary Health Care Center 4 Vaccination 2

OPD 2

Pediatric Department 4 Inpatient & Emergency

Room 4

Obstetrics & Gynecology 8

Gyne ward 2

Maternity/Obstetric

Department (Antenatal

and postnatal)

2

Obstetric ER 2

Labour Room (LR) 2

Clinical Elective Rotation 4 weeks

Clinical Elective Rotation shall be undertaken in any of the above clinical rotation areas or

any other clinical areas such as the:

- Emergency Department.

- Intensive Care Unit.

- Pediatric ICU

- Neonatal ICU.

- Burn Department.

- Oncology Department.

The intern has define the elective area 2 months ahead to allow internship unit to communicate

with the health care agencies.

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Taibah University

College of Nursing

Internship Unit

Instructions for the Clinical Instructors (Preceptors).

All clinical instructors/preceptors need to follow the following key assessment procedure in

assessing nurse interns' performance on each skill in the log book.

Level of Performance: The nurse intern performed the skill task independently under

supervision (including team-work skills, as part of the team).

Performance is measured on two dichotomy:

- Satisfactory: the nurse intern completed the skill task successfully.

- Unsatisfactory: the nurse intern failed to perform the skill task successfully

Not Applicable: the skill is either not applicable or not available at clinical setting and

the nurse intern was not able to observe and perform it. Once selected, the nurse intern

will not be assessed for this skill.

For each skill/task performed by intern, the immediate trainer (clinical instructor/

preceptor/staff nurse trainer) will sign (with initials and date) in the appropriate column

under the level of performance (see the example in the next page).

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Taibah University

College of Nursing

Internship Unit

Example for the Signatures in the Log Book

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Taibah University

College of Nursing

Internship Unit

Attendance Record Nurse intern name: ____________________________________________________________

Department/Unit: _________________________________ Month ________________ Days Clinical Department Time in Time out Signature Remarks

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31.

Days Absent

Sick Excused Unexcused Vacation

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Taibah University

College of Nursing

Internship Unit

Basic Nursing Care Skills

The following are basic nursing skills that normally repeated in each rotation. To avoid the

repetition of these skill in this logbook, clinical instructor needs to refer to this list when

assess the nurse intern in these basic care skills in each rotation.

Performing admission procedures.

Performing discharge procedures.

Receiving and handover of patient (end of shift endorsement).

Complying with infection control and safety measures.

Performing documentation.

Using effective therapeutic communication skills.

Complying with hospital policies and procedures.

Adhering to professional standers of legal and ethical practices in providing culturally

sensitive care that respects patients' rights, values customs and religious beliefs.

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Taibah University

College of Nursing

Internship Unit

Medical Department

Period of rotation: From _______________________ To _______________

No. of days absent with leave _____________ without leave__________

Attendance: a) Regular / Irregular. b) Punctuality – Yes / No

Objectives of Training in the Medical Department.

By the end of training in the medical department, the nurse intern will be able to:

1. Follow rules and regulation of infection control.

2. Demonstrate skill of history taking and physical examination.

3. Use the nursing process in providing patient care.

4. Perform the routine nursing care (hygienic, feeding, positioning, elimination, …..)

5. Prepare and assist with diagnostic and therapeutic procedures in medical department.

6. Demonstrate a basic level of proficiency in prerequisite mathematical calculations

for medication administration.

7. Demonstrate skills of medication &IV therapy administration.

8. Safely initiate, maintain, and terminate the hemodialysis treatment.

9. Adhere to hospital policies and procedures.

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

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

Clinical Skill/Task Level of Performance Not

Applicable Satisfactory Unsatisfactory

Basic nursing care skills (refer to page 11)

Measure and Document the Vital Signs

Axillary/oral temperature

Radial pulse (rate/rhythm/force/volume) & apical pulse

Use of pulse amplitude

Respiration rate/character/pattern

Blood pressure (manual and automatic)

Utilize the Nursing Process in the Care of the Patient

Obtains comprehensive patient’s health history.

Perform Complete Physical Assessment

- HEENT assessment

- Respiratory assessment.

- Cardiovascular assessment.

- Neurological assessment and GCS.

- Musculo-skeletal assessment.

https://en.wikipedia.org/wiki/HEENT_examination

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Taibah University

College of Nursing

Internship Unit



- GIT and abdominal assessment.

- Genitourinary assessment.

Formulate nursing diagnosis and sets attainable and

measurable objectives.

Develop a nursing care plan appropriate for identified

nursing diagnoses

Implement the nursing care plan.

Evaluate effectiveness of the nursing care.

Prepare and Administer Medications:

Calculate medication dosage

Per OS (by mouth).

Per NGT

Per rectum

Subcutaneous injections.

Intravenous injections.

Intramuscular injections.

Topical: skin, eye, nose, and ear.

Mixing two insulins in one syringe

Chemotherapy

Collect the Samples (Specimen) for Laboratory Tests:

Blood samples.

Blood culture.

Swabs: ear, nose, throat, wound.

Drainage fluid sample.

Sputum sample by expectoration.

Urine samples: random, mid-stream clean catch, first

morning, and catheter sample collection.

Stool sample.

Assist with Safe Preparation and Post Procedure Care for the following Procedures:

X ray and ultrasound.

CT Scan/MRI.

Endoscope/Bronchoscope.

Prepare Patient and Equipment and Assist with:

Lumbar puncture

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Taibah University

College of Nursing

Internship Unit



Bone marrow puncture

Thoracentesis

Paracentesis

Liver biopsy and liver abscess aspiration.

Prepare and Perform the Following Procedures:

Recording the 12-leads ECG.

Gastric tube (insertion, care, and removal).

Gastric wash/lavage.

Bolus enteral tube feeding.

Blood sugar monitoring by gulco-check machine.

Urinary catheters (insertion, care & removal).

Condom catheter to male patient.

Urine screening for sugar, albumin, acetone.

Bed making (unoccupied bed)

Bed making (occupied bed)

Understanding Code Blue Management

Provide Nursing Care and Management of Patient with:

Cardiovascular disorders (such as IHD, heart failure,

hypertension, cardiomyopathy, pericarditis, pericardiac

effusion, peripheral vascular disorders, etc.)

Respiratory disorders (such as COPD, asthma,

pneumonia, PE, pleural effusion, fibrosis, etc).

Neurological disorders (such as stroke, meningitis,

encephalitis, epilepsy, myasthenia gravis, Guillain-Barré

syndrome, etc)

Endocrine disorders (such as DM, pituitary disorders,

thyroid and parathyroid disorders, adrenal disorders, etc.)

Hematological disorders (such as anemias, leukemia,

hemophilia, thrombocytopenia, hypercoaguable state etc.)

Gastrointestinal disorders (such as liver disease,

cholecystitis, peptic ulcers, colitis, diverticulitis, etc.)

Renal failure/hemodialysis.

Name Signature Date

Head Nurse/Charge Nurse

Head of the Continuing Education

Stamp

http://www.heart.org/HEARTORG/Conditions/More/What-is-Pericarditis_UCM_444931_Article.jsp

https://en.wikipedia.org/wiki/Encephalitis

https://en.wikipedia.org/wiki/Epilepsy

https://en.wikipedia.org/wiki/Myasthenia_gravis

https://en.wikipedia.org/wiki/Guillain-Barr%C3%A9_syndrome

https://en.wikipedia.org/wiki/Guillain-Barr%C3%A9_syndrome

http://www.endocrineweb.com/conditions/pituitary-disorders/all

http://www.endocrineweb.com/conditions/hyperthyroidism/hyperthyroidism-overview-overactive-thyroid

http://www.endocrineweb.com/conditions/hypoparathyroidism/hypoparathyroidism

16






Taibah University

College of Nursing

Internship Unit

Hemodialysis Unit (Artificial Kidney Unit)



Attendance: a) Regular / Irregular. b) Punctuality – Yes / No

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

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




Preparation of patient for hemodialysis.

Pre-dialysis patient assessment.

Set up and Test the Delivery System.

Perform system start up procedure

Priming dialyzer

Perform alarm systems function test

Perform manual conductivity test

Perform manual temperature test

Perform manual pH test

Perform manual pressure holding test.

Perform basic operator troubleshooting

Administers heparin bolus through venous line.

Perform the Vascular Access Procedures.

Assesses access for function and lack of

pathology.

Cleans needle site with appropriate disinfectant.

Cannulates fistula at 25 angle and AV graft at

45 angle.

Pre-dialysis CVC care and dressing change.

Connect patient to machine and initiates dialysis with

internal vascular access/with CVC

Collect Blood Specimens

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Taibah University

College of Nursing

Internship Unit



Provide Care and Monitor the Patient and Equipment During Hemodialysis.

Systemic assessment of patient and the patient

subjective response to treatment.

Monitor volume status.

Monitor vascular access function.

Monitor arterial and venous pressures and blood

flow rate.

Management of anticoagulation.

Ultrafiltration calculation

Administer mannitol, blood & blood product.

Perform Machine Alarm Troubleshooting Procedures

Blood leak alarm.

Arterial pressure alarm.

Venous pressure alarm.

Conductivity alarm.

Ultrafiltration alarm.

High temperature alarm.

Air/foam detector alarm.

Power failure alarm.

Blood pump alarm.

Management of the Dialysis Patient With:

Fluid overload/ hypertension.

Hypotension.

Disequilibrium syndrome.

Hyperkalemia.

Seizures / muscle cramps

Poor blood flow rate from catheter

Filter blood leak

Air embolus

Hemolysis.

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Taibah University

College of Nursing

Internship Unit



Pyrogenic reaction.

Chest pain.

Cardiopulmonary arrest.

Properly Discontinues Dialysis with Internal Vascular Access/with CVC.

Return of blood.

Performs post dialysis vascular access care.

Properly assesses access for function and

cessation of bleeding from needle sites.

Perform the Equipment Clean Up and

Sterilization.

Properly cleans and disinfects exterior of

machine.

Perform the machine chemical disinfection.

Perform the standard rinse/ acetic acid rinse/

bleach rinse procedure.

Peritoneal Dialysis

Prepare and assist with peritoneal dialysis initiation.

Care and monitor patient during peritoneal dialysis

Care and maintenance of exit sites for peritoneal

dialysis

Obtain blood sample and follow laboratory blood

works

Name Signature Date



Stamp

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Taibah University

College of Nursing

Internship Unit

Surgical Department



Attendance: a) Regular / Irregular b) Punctuality – Yes / No

Objectives of training in the Surgical Department.

By the end of the training in the surgical department, the nurse intern will be able to:

1. Provide preoperative nursing care.

2. Provide immediate and routine post-operative nursing care.

3. Provide the care for patient with common surgical disorders.

4. Prepare and assist with diagnostic and therapeutic procedures in surgical department.

5. Provide direct nursing care for patients with common surgical interventions.

6. Provide wound care and the care for diabetic foot.

7. Demonstrate skills and roles of scrub nurse and circulating nurse in operation room.






Safely lift a patient:

Bed to chair/chair to bed.

Bed to trolley/Trolley to bed.

Use a “draw sheet” effectively

Transport patients on a stretcher

Transport patients in wheel chair

Apply the external heating/cooling device (use of

hyper/hypothermia blanket).

Insert, maintain & remove the peripheral IV cannula.

Perform blood and blood products transfusion.

Whole blood

PRBCs

Platelets

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Taibah University

College of Nursing

Internship Unit



Fresh frozen plasma.

Preoperative Management.

Organize chest x-rays, ECG, blood work and

check pre-operative checklist.

Teach patient.

Prepare the patient’s skin

Prepare and administer the enema.

Perform specific preoperative preparation.

Transfer patients to OR and from recovery room.

Post-Operative Management

Receive patient from OR and position him in bed

Provide the immediate post-operative care

Assess the pain level.

Assess the neurovascular status.

Guide the patient using of incentive spirometry.

Measure fluid intake and output.

Assist with early ambulation

Wound Care and Surgical Dressing.

Assess wound and select appropriate dressing

materials

Setup of sterile surgical field, add the supplies

and pour solution aseptically.

Change surgical dressing aseptically.

Cleanse, irrigate, pack, and dress the open wound.

Obtain wound culture (swab for C/S).

Monitor and care of drains/hemovac devices.

Remove drain

Remove sutures and staples.

Care and change dressing for diabetic foot.

Assess and record the stoma condition.

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Taibah University

College of Nursing

Internship Unit



Irrigate colostomy and perform stoma site care

Apply/change the stoma appliances for the

colostomy (bags, wax).

Provide the care of the patient with a chest tube

and underwater seal drainage system.

Prepare and assist with pleural/ mediastinal chest

tube removal.

Renal/Urologic Management.

Insert, care, and maintain the three way

indwelling urinary catheter.

Perform and maintain intermittent and continuous

closed bladder irrigation

Provide the care of nephrostomy tube

Provide care of urostoma and urinary diversions

Prepare & assist with suprapubic catheter insertion

Provide the care of the suprapubic catheter.

Safe Preparation and Post Procedure Care for the Following Procedures

Colonoscopy

Endoscopic Retrograde

Cholangiopancreatography (ERCP).

Upper GI Series (barium swallows)

Lower GI Series ( barium enema )

Intravenous urography (IVP), cystography, and

renal angiography

KUB and ultrasonography.

Biopsy (renal and ureteral brush biopsy).

Extracorporeal shock wave lithotripsy (ESWL)

Orthopedic and Care of Tractions

Prepare patient for traction application

Maintain and care of traction (skin and skeletal)

Provide the pin care.

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Taibah University

College of Nursing

Internship Unit



Maintain and care of spinal skeletal traction

(skeletal tongs or calipers, and halo device)

Prepare materials and patient for cast application.

Provide plaster cast care & after cast removal care

Apply the bandages and slings

Provide Nursing Care and Management of Patient with:

Post open cardiac surgery

Thoracotomy/Lobectomy/Pneumonectomy

Head injury.

Spinal cord injury

Craniotomy and brain surgeries

Amputation

Pinned fractures

Total hip/Total knee replacement

Paralytic ileus/Bowel obstruction

GI surgery

Nephrectomy

Renal transplant

Transurethral resection of prostate (TURP).

Urinary diversion

Thyroidectomy

Traumatic wounds

Name Signature Date



Stamp

https://www.google.com.sa/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjKt9Oe7ujJAhUFWhoKHQnhDWQQFggcMAA&url=http%3A%2F%2Fwww.mayoclinic.org%2Ftests-procedures%2Fturp%2Fbasics%2Fdefinition%2Fprc-20020214&usg=AFQjCNHD8WOZdRNTetkvid_JXCL0AjHPew&sig2=RJeMZidp7FotRSyL1UtNuQ

23






Taibah University

College of Nursing

Internship Unit

Operation Room Period of rotation: From _______________________ To _______________


Attendance: a) Regular / Irregular b) Punctuality – Yes / No






Before the Operation

Receive patient from surgical department and

provide psycho-social support for patients.

Prepare operation table.

Prepare operation instrument tables/trolleys

(sterile field), sheets and instruments

(circulating nurse).

Anticipates, provides and arranges properly the

needed supplies and equipment for the

operation.

Perform vital signs and haemodynamic

monitoring.

Position patients for operative procedures –

standard surgical positions.

Perform surgical scrubbing using correct

technique and timeframe (scrub nurse)

Perform sterile gowning and gloving (scrub

nurse)

During the Operation:

Keeps track of instruments as to location and

numbers (scrub nurse/circulating nurse)

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Taibah University

College of Nursing

Internship Unit



Anticipates the needs of the surgeon and the

surgical team with confidence (scrub

nurse/circulating nurse)

Accurately counts and promptly records

sponges and instruments before the cutting

time, and the closing time.

Maintain sterile field-aseptic technique:

maintains sterility of supplies, equipment and

area at all times

After the Operation:

Accurately counts and promptly records

sponges and instruments after closing time

(scrub nurse/circulating nurse).

Helps in application of dressing.

Provide immediate post-operative care.

Assist in cleaning the OR suite/theater after

use, in preparation the OR for the next

case/use.

Disposes waste material properly

Name Signature Date



Stamp

25






Taibah University

College of Nursing

Internship Unit

Emergency Department (ED) Period of rotation: From _______________________ To _______________


Attendance: a) Regular / Irregular. b) Punctuality – Yes / No.

Objectives of Emergency Department:

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

1. Receive patient at triage area and categorize them.

2. Identify the appropriate action for the emergency situation.

3. Provide nursing care for patients with common emergency problem.

4. Prepare equipment and assist in emergency procedures.

5. Document clearly according to hospital policy.

6. Calculate and administer the common emergency medication.

7. Communicate effectively with patients and their families, and other colleagues.

8. Develop leadership skills.






Check crash cart contents, test the defibrillator

safely, and accurately reporting any discrepancies.

Perform the Emergency Assessment

Primary Assessment (A,B,C,D,E)

Secondary Assessment

Perform the Triaging: able to demonstrate & assist

in prioritizing patients management

Life Saving Interventions

Perform BLS procedures

Provide the bag-valve-mask ventilation

Participate in ACLS and administer ACLS

drugs

Prepare and assist with defibrillation /

cardioversion

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Taibah University

College of Nursing

Internship Unit



Airway Management

Insert the nasopharyngeal airway.

Insert the oropharyngeal airway.

Prepare and assist with the tracheal intubation

Prepare and assist with the tracheostomy

Insert the laryngeal mask airway

Perform the naso- and oropharyngeal

suctioning.

Perform the endotracheal tube and

tracheostomy suctioning.

Insert the peripheral IV catheter and withdraw

blood sample.

Priming and regulating IV fluid

Provide the IV fluid resuscitation

Prepare and assist with insertion and set up of the

central venous line and the Quinton catheter.

Prepare and assist with cutdown.

Perform Allen's test and obtain arterial blood sample

Interpret arterial blood gases results

Apply pulse oximetry to the patient

Measure the peak expiratory flow rate by the peak

expiratory flow meter

Provide O2 therapy by

Nasal cannula.

Simple face mask.

Rebreathing and Non-Rebreathing Mask

Venturi mask.

Administer medication by inhalers and nebulizer.

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Taibah University

College of Nursing

Internship Unit



Administer common emergency medications.

Administer the thrombolytic therapy.

Prepare chest drainage system (Pleurevac drainage)

Prepare (patient and equipment) and assist with

chest tube insertion

Prepare patient and equipment, and assist with

pericardiocentesis.

Prepare and assist with esophagogastric

Tamponade Tube insertion (Sengstaken-

Blakemore tube).

Perform the saline gastric lavage.

Provide the care for open and traumatic wound.

Set up suture tray and assist with wound closure

(by suturing and staples).

Perform eye irrigation and apply the eye patch.

Perform nasal packing

Immobilize cervical spine by cervical collar.

Immobilize spine with the long spine board.

Stabilize fractures with splints (including cast splint)

Receiving and transferring patient from the

ambulance or private car to the emergency trolley.

Name Signature Date



Stamp

28






Taibah University

College of Nursing

Internship Unit

Intensive Care Unit Period of rotation: From _______________________ To _______________



Objectives of Intensive Care Unit Rotation.

Upon completion of the clinical training in the ICU, the nurse intern will be able to:

1. Demonstrate high technical skills in caring for critically ill patients in ICUs.

2. Prioritize care to critical care patients.

3. Demonstrate confidence in clinical decision making within the professional nursing role

in the critical care setting.

4. Integrate knowledge from nursing science in the nursing care of critically ill patient.

5. Prepare equipment and assist in critical care procedures.

6. Calculate and administer the common ICU medication.

7. Communicate effectively with patients and their families and colleagues.






Perform endotracheal tube care (changing position,

changing the tie and fixation)

Perform tracheostomy and tracheostomy tube care.

Perform ETT/tracheostomy tube suctioning.

Provide endotracheal/ tracheostomy tube cuff care.

Perform chest physiotherapy.

Collect sputum sample by suction.

Set up ventilator, adjust the ventilator setting as

prescribed and test the alarm system.

Initiate invasive & noninvasive mechanical

ventilation as prescribed.

Provide the care of mechanically ventilated patient.

Trouble shooting the ventilator alarms.

Assist in weaning from mechanical ventilation.

Perform extubation according to physician order.

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Taibah University

College of Nursing

Internship Unit



Provide O2 by tracheotomy mask and T-piece

Monitor the end-tidal CO2 (capnograph monitoring)

Set up cardiac monitor, adjust and test the alarm

system and initiate the cardiac monitoring.

Perform basic 12 lead ECG interpretation and basic

arrhythmia interpretation.

Prepare ICU bed for post-cardiac surgery patient

Receive the post-cardiac surgery patient.

Prepare and assist with insertion and set up of:

Arterial line

PA catheter/Swan-Ganz catheter.

Temporary pacemaker (transcutaneous

/transvenous).

Set up and zeroing a pressure transducer and

monitoring system for the CVP and arterial line.

Obtains CVP readings using a water manometer and

pressure monitor.

Provide care for the central venous line/PA catheter.

Provide care for arterial catheter and arterial line.

Flush central venous line

Draw blood from central venous line/ PA catheter

Administer IV push medications and fluids through

the central venous line.

Draw blood from arterial line

Remove central venous line.

Remove arterial line

Provide care of patient with a pacemaker

Provide the pre/post angioplasty /cardiac cath (PCI)

Use IV infusion pumps and IV syringe pumps

Prepare and set up the CRRT system and machine.

Initiate the CRRT

Provide the care of patient on CRRT

Provide care for patient with increased ICP.

http://www.resuscitationcentral.com/ventilation/capnography-end-tidal-co2/

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Taibah University

College of Nursing

Internship Unit



Obtains ICP readings accurately using ICP monitor.

Provide care of patient undergoing ICP monitoring

Administer continuous enteral feeding by pump

Administer of enteral feeding through gastrostomy/

jejunostomy tube

Administer TPN, PPN and lipids.

Provide perineal care

Provide eye care

Provide oral care

Provide hair care

Provide complete/partial bed bath.

Provide care for patients with respiratory disorders

(such as respiratory failure, ARDS, pulmonary

edema, pulmonary embolism, severe asthma, and

COPD exacerbation).

Provide care for patients with cardiovascular

disorders (such as ACS, post cardiac arrest, and

immediate post open-heart surgery).

Provide care for patients with neurological disorders

(such as stroke/coma, brain injury, brain edema,

increased ICP, and spinal cord injury).

Provide care for patients with liver failure/hepatic

coma, severe acute pancreatitis and paralytic ileus.

Provide care for patient with diabetic comas.

Provide care for patient with renal disorders: acute

renal failure and renal transplant

Provide care for patient with shock and multi-system

organ failure.

Name Signature Date



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http://www.aann.org/uploads/AANN11_ICPEVDnew.pdf

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Taibah University

College of Nursing

Internship Unit

Pediatric Department




Objectives of training in the Pediatric Department.

By the end of the training in the pediatric department, the nurse intern will be able to:

1- Assess growth and anthropometrics & recording on graph.

2- Demonstrate skills of history taking (assessment of newborn, preterm & pediatric).

3- Perform physical examination for every child correctly and completely.

4- Assess the signs and symptoms of common serious childhood illnesses.

5- Perform nursing care for common pediatric medical and surgical disorders.

6- Assist in common diagnostic and therapeutic procedures.

7- Provide health teaching to the parent.






Take pediatric health history.

Perform complete pediatric physical assessment.

Assess infant/child growth & development:

Weight and height.

Head, chest and abdominal circumference.

Record on growth graph.

Measure & document pediatric vital signs:

Pulse

Respiration,

Blood pressure.

Temperature: axillary and rectal by glass and

electronic thermometer, and by tympanic probe.

Apply pulse oximeter to the neonate, infant and child

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Taibah University

College of Nursing

Internship Unit



Administer oxygen therapy by simple face mask, nasal

cannula, and head box/hood.

Obtain capillary blood sample from the heel.

Perform vein puncture and withdraw blood sample

Insertion of peripheral IV cannula

Provide the care of IV Heplock/cannula and perform

cannula flashing.

Prim tubing & regulate the flow rate of IV fluids.

Calculate the pediatric medication dosage

Prepare and administer medications:

Oral

Rectal

Parenteral medications (SC, IV and IM).

By nebulizer/inhaler

Prepare and administer the ORS.

Prepare and provide bottle feeding.

Insert, care, and remove gastric tube.

Prepare and administer gavage feeding

Administer TPN/PPN as prescribed.

Provide the phototherapy.

Use radiant warmer.

Perform chest physiotherapy.

Perform passive exercise/guide the child for active

exercise

Perform the paediatric/neonate hygiene safely

Complete/partial bath.

Mouth care

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Taibah University

College of Nursing

Internship Unit



Eye care.

Diaper care.

Make up a bed/cot.

Use bedrails appropriately and use restraints when

required

Lift and transport pediatric patient.

Provide nursing management for child with common

medical disorders.

Provide pre-operative and post-operative care for the

child with common surgical disorders.

Prepare pediatric patient for discharge (give patient &

parents health teaching about appointments,

medications, diet & any special instruction).

Name Signature Date



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34






Taibah University

College of Nursing

Internship Unit

Maternity/Obstetric Department

(for female nurse intern)




Objectives of the Maternity/Obstetric Department Rotation

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

1. Take complete history and perform physical assessment and examination for

pregnant woman and mother’s in the postpartum period.

2. Formulate nursing diagnosis addressing woman unmet need according to priorities.

3. Perform nursing interventions and nursing care based upon the formulated plans.

4. Provide nursing care by applying nursing process for high risk pregnant women.

5. Provide nursing care for post partum women.

6. Perform perineal care and episiotomy car.

7. Instruct women about post partum perineal self-care.

8. Provide antenatal and postnatal health education regarding breast feeding, schedule

of immunization, family planning methods, nutrition and exercise.





Basic nursing care skills (refer to page 11) ANTENATAL. Obtain the OB history and estimated date of delivery.

Perform physical examination of pregnant patient/

obstetric examination.

Perform breast examination.

Perform Leopold's maneuvers (abdominal maneuver).

Assist with pelvic examination during pregnancy.

Auscultate & record fetal heart rate using Pinard

stethoscope & Doppler

Test urine for protein & sugar using urinary dipstick.

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Taibah University

College of Nursing

Internship Unit



Assist with non-stress test (NST).

Perform the external cardiotocography (CTG):

Set–up the and apply CTG machine

Apply CTG machine.

Monitor contraction and fetal heart rate

Interpret CTG reading & reporting abnormalities &

providing care as indicated.

Assist in ultrasound

Assist the patient with self-care and perineal care.

Assist the patient with breast care

Observe and recognize blood loss through vagina (P.V

loss)

Assist with Prostin vaginal tablets insertion.

Prepare patient for CS (preoperative care)

Care of high risk patients:

Toxemia

Ante partum hemorrhage (APH )

Pre–eclampsia

Multiple Pregnancy

Diabetic Mother/ Gestational Diabetes

Anaemia

History of cardiac disorders

History of renal disorders

Care of patients with complicated pregnancy

Intrauterine growth restriction (IUGR)

Premature rupture of membranes (PROM)

Premature Labour

Intrauterine fetal death (IUFD)

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Taibah University

College of Nursing

Internship Unit



POST-NATAL.

Administer of oxytocin injection and infusion as prescribed

Perform the postpartum assessment:

Monitor vital signs and pain level

Exam abdomen and assess fundal height.

Assess the Lochia

Observe for vaginal bleeding/ perform the pad

measurement

Assess Perineum condition.

Assessment of lower legs

Perform uterine massage

Perform episiotomy care

Assist with self-perineal care

Provide breast care

Assist/support breast feeding

Provide postoperative care for patient with CS

Provide post partum health education about:

Routine newborn care & hygiene

Establishment of breast feeding

Breast care

Post-natal exercise

Milk Formula’s: Types & rationale, preparation and

sterilization of bottles & teats

Immunization schedule

Name Signature Date



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37






Taibah University

College of Nursing

Internship Unit

Labour Room

(for female nurse interns)




Objectives of the Labour Room Rotation.

By the end of training in labour room, the nurse intern will be able to:

1. Prepare woman for normal vaginal delivery and for emergency cesarean section.

2. Perform vaginal examination during labour.

3. Assess mother's general & local condition during labour (using partogram).

4. Provide nursing care during stages of labour.

5. Prepare and assist in episiotomy incision and repair.

6. Perform immediate newborn baby assessment and care.






Measure and record vital signs

Palpate abdomen and determine the fetal position

Assess uterine contractions

Establish an IV line/ collect of blood works

Administer fleet enema as indicated

Insert urinary catheter and test urine

Management of Patient in Labour: Monitor contraction and fetal heart rate

Use/fill the Partogram

Perform vaginal examination & assess cervix dilation

Set up the delivery table

Set up the trolley and instruments for delivery,

episiotomy and suturing.

38






Taibah University

College of Nursing

Internship Unit



Apply pain relief methods (pharmacology &

nonpharmacology)

Assist with normal vaginal delivery

Assist with episiotomy & repair

Administer the drugs (Syntocinon and Methergin)

Prepare and Assist with Assisted Delivery

Forceps

Ventouse or Vacuum Extraction

Breech Presentation

Emergency Cesarean Section

Provide the Immediate Baby Care Suction the baby and clear the airway.

- Bulb syringe/nasal suctioning/ oral suctioning

Measure the Apgar Score

Dry and wrap the baby

Administer of oxygen as indicated

Prepare for and assist with newborn resuscitation.

Provide eye care

Assess/examine the newborn baby

Measure the baby head circumference, weight & height

Collect of blood from umbilical cord

Apply identification of newborn

Fill in the proper documentation

Immediate Postpartum Care of Mother. Inspect the placental membranes

Assess the uterus and perform uterus massage

Assess Lochia/check for post-partum hemorrhage

Provide the perineal - episiotomy care.

Check criteria for transfer to obstetric unit.

39






Taibah University

College of Nursing

Internship Unit



Filling in the birth register and the obstetrical booklet

Prepare and Assist with Emergency Interventions and

Perform Nursing Management for Patient with:

Abruptio Placenta

Placenta Previa

Ruptured Uterus

Eclampsia

Hemorrhage (Ante-Natal /Post partum)

Cord Prolapse

Fetal distress

Name Signature Date



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40






Taibah University

College of Nursing

Internship Unit

Gynecology Department Rotation




Objectives of the Gynecology Department Rotation.

By the end of Gynecology clinical training the nurse intern will be able to:

1. Provide adequate preparation according to standard precautions before any obstetrics

and gynecologic procedures.

2. Apply post procedure tasks after finishing any invasive and non-invasive procedure

related to gynecologic problems.

3. Perform all nursing procedures related to care of the women during gynecological

and family planning procedures.





Perform Physical Health Assessment

Perform breast examination

Prepare and assist in pelvic examination

Assist in ultrasound

Perform Vaginal irrigation/ Vaginal douching

Insert of vaginal suppositories or cream

Prepare and assist in vaginal packing

Prepare and assist in vaginal pack removal

Prepare and assist in the insertion of IUD

Perform pre-operative shaving

Provide the Pre-Operative and Post-Operative

Care for Patient Undergoing:

Dilatation & Curettage

Vaginal operations

Anterior and posterior repair

Hysterectomy (abdominal /vaginal)

Tubal ligation (abdominal )

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Taibah University

College of Nursing

Internship Unit

Laparotomy

Fistula repair

Provide Nursing Care of Patients with

Hyperemesis Gravidarum

Ectopic pregnancy

Pelvic Inflammatory Disease

Abortions

- Threatened

- Inevitable

- Incomplete

- Missed

Secondary post - partum hemorrhage

Ovarian cyst

Hydatiform mole

Urinary incontinence

Gynecology Oncology

Name Signature Date



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42






Taibah University

College of Nursing

Internship Unit

Primary Health Care









Screen urine for glucose, ketones, and protein.

Assess and Record the Vital Signs

Temperature by axillary, oral, rectal, or tympanic

Pulse: apical rate and radial rate

Respiration

Blood pressure

Antenatal Care.

Measure the mother’s weight and height.

Measures mother blood pressure & pulse

Perform physical examination.

Perform Leopold maneuver

Auscultates abdomen to listen to fetal heart sound

Checks the woman fore danger signs of pregnancy

Assess for pitting edema

Gives the woman the necessary instructions & date

of next visit

Obtain the pediatric anthropometric measurements

Measures weight and length

Measures head, chest, and abdomen circumference

Fill the growth chart and assessing for the normal

growth & development.

43






Taibah University

College of Nursing

Internship Unit



Vaccination Clinic

Administer IM injection for infants

- Rectus femoris (mid anterior thigh)

- Vastus lateralis (middle third thigh)

Administer IM injection for toddlers and school age

(poster dose).

- Posterior gluteal (upper outer quadrant )

- Ventro gluteal

- Deltoid

- Lateral and anterior aspect of the thigh

Administer intradermal injection

Administer subcutaneous injection

Provide health education to mothers about normal

reaction of vaccine and action

Dressing Room

Provide wound care.

Remove the sutures.

Chronic Diseases Clinic

Collect urine sample: mid-stream or random

Check blood glucose by using gluco-check machine

Administer oxygen therapy by low devices system:

nasal cannula/ simple face mask

Administer medications by small volume nebulizer

Administer medications by IM, IV, SC injections

Name Signature Date



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44






Taibah University

College of Nursing

Internship Unit

Psychiatry Department




Objectives of the Psychiatry Department Rotation.

Upon completion of the training in psychiatry department, the nurse intern will be able to:

1. Apply, with direction, the principles and concepts of primary health care specific to

nursing contexts at a beginning level.

2. Use reflective practice, critical thinking and evidence-based practice in clinical

decision-making.

3. Demonstrate the knowledge and skill necessary for nursing assessment and screening

with children and adults.

4. Demonstrate skills of therapeutic communication and needs assessment when

working with children, adults, families and communities.

5. Apply principles of social justice, cultural safety and equity in primary health care

6. Demonstrate, with guidance, clear and accurate documentation in line with legal and

ethical requirements in the primary health care setting.





Basic nursing care skills (refer to page 11).

Perform the initial nursing assessment

Perform mental status and neurological examination.

Perform the suicide risk assessment.

Use the Therapeutic Approaches:

Behavior therapy (behavior management techniques)

Cognitive-behavioral treatment

Dialectical behavior therapy (DBT)

Hypnosis

Therapeutic limit settings

Group psychotherapy.

Family therapy

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Taibah University

College of Nursing

Internship Unit



Individual psychotherapy

Milieu therapy (use of milieu to enhance patient care

and to decrease confusion and tension)

Impulse control techniques

Relaxation therapy

Activity and recreation therapy

Social and vocational training

Patient teaching

Use therapeutic communication skills

Use therapeutic verbal communication

Limits use of non- therapeutic verbal communication

Use non- verbal communication: uses of appropriate

gestures and distance for patient personal space.

Administer and monitor for the following medications:

Controlled medicine (Narcotics)

Antabuse

Anticonvulsants

Antidepressants

Antipsychotics

Benzodiazepines/Anxiolytics

Anti-cholinergic drugs

Methadone

Mood stabilizers

Attention deficit hyperactivity disorder (ADHD)

medications

Prepare and assist in electro-convulsive therapy (ECT)

Apply suicidal precautions and manage patient with

assaultive behavior

Apply seizure precautions and manage patient with seizures

Manage drug/alcohol detox/withdrawal symptoms

46






Taibah University

College of Nursing

Internship Unit



Perform rapid tranquilization as prescribed.

Perform chemical restraints (by drugs) as prescribed

Perform isolation procedures (seclusion) & observation.

Apply and assess the physical restraint:

Ambulatory cuffs

Full restraints.

Wrist restraints

Care and handles patient with: Anxiety and anxiety disorders

Schizophrenia

Mood disorders and suicide

Personality disorders

Cognitive disorders

Substance Abuse (alcoholic patient and drug

dependent patient)

Eating disorders

Somatoform disorders

Perform discharge planning

Name Signature Date



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47






Taibah University

College of Nursing

Internship Unit

Nursing Administration Department




Objectives of Nursing Administration Rotation:

Upon completion of the training in the nursing administration, nurse intern will be able to:

1. Apply roles of the first line nurse manager (head nurse) in the department.

2. Admit, discharge, and transfer the patients.

3. Submit a shift report in a particular department.

4. Apply various methods of patient care delivery system

5. Develop time schedule for nursing staff.

6. Evaluate the performance of the staff.

7. Fill certain types of records & reports forms that used in nursing unit

8. Assess and apply different roles of top level management

9. Develop leadership skills.

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


Clinical Skill/Task

Level of Performance Not


Prepare for new admission

Prepare patient file with essential formats of recording and

reporting.

Follow and implement hospitals policies and procedures

related to:

Patient admission

Patient discharge.

Patient transfer

Patient death

Documents complete, accurate, pertinent information in a

timely manner according to agency policy.

Uses appropriate channels of communication.

Check absentissem of nursing staff

48






Taibah University

College of Nursing

Internship Unit

Conduct daily planned patient care assignment

Develop time scheduling

Attend medical round with physicians

Utilize staff appropriately

Distributes special duties to staff (crush trolley, medication

…..etc.)

Supervise nursing care of nursing staff /Staff performance

appraisal.

Conduct shift report per shift/hand over report.

Write incident report

Conduct orientation for newly appointed staff

Maintenance of records and reports

Ordering the needed medication and supplies

Distributes supplies to nursing staff

Provide the appropriate care of equipment

Request for maintenance for equipment that needs

maintenance

Make inventory list of supplies and equipment

Check unit cleanliness and organization

Demonstrate appropriate behavior (attendance, punctuality,

appearance, honesty, attitude, accept criticism, etc.)

Conveys mutual respect, trust, support, and appreciation

for other members of the health care team.

Treats all individuals with dignity and respect.

Name Signature Date



Stamp

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