Documente Academic
Documente Profesional
Documente Cultură
REGIONAL EXAMINATION
FOR NURSE REGISTRATION
CARICOM COUNTRIES
1
TABLE OF CONTENT
Page No
ACKNOWLEDGEMENT………………………………………………... v
INTRODUCTION……………………………………………………….. 1
RATIONALE ……………………………………………………………. 2
2. Needs ………………………………………………………. 12
B. Nursing ……………………………………………………… 21
2
Maintaining Needs Satisfaction Throughout the Life
Cycle ………………………………………………………………… 30
APPLICATION OF THE NURSING PROCESS TO INDIVIDUALS
WITH BASIC NEEDS INTERFERENCES
Outline ………………………………………………………………. 40
Example I:
Needs Interferences of the
Pre-School Child (1-4 years) (Gastro-Enteritis) ……………..………… 41
Example II:
Needs Interferences of the School-Child
(5 – 11 years)(Learning Disabilities) ………………………………….. 45
Example III:
Needs Interferences of the Pregnant Adolescent
(12 –19 years)(Pregnancy) ………………………………………..…… 51
Example IV:
Needs Interferences of the Young Adult
(20 – 44 years)(Hysterectomy) (Fibromyoma of
Uterus) ……………………………………………………………….… 57
Example V:
Needs Interferences of the Young Adult
(20 – 44 years)(Hyperactivity) (Anxiety Neuroses) ……………………. 62
Example VI:
Needs Interferences of the Adult (45-64 years)
(Diabetes Mellitus) ………………………………………….………… 68
Example VII:
Needs Interferences of the Older Adults (65 + years)
(Senility) ………………………………………………………………. 73
ANNEX I, TABLE I:
COMMON HEALTH PROBLEMS IN THE CARIBBEAN –
ARRANGED BY AGE GROUPS AND CATEGORIES ……………… 84
3
ANNEX II, TABLE II:
CORE LIST OF NURSING SKILLS FOR
SCHOOL-BASED ASSESSMENT ……………………………………. 94
ANNEX III:
GUIDELINES FOR THE USE OF CORE LISR OF NURSING
SKILLS FOR ASSESSMENT OF CANDIDATES …………………. 102
ANNEX IV:
CRITERIA FOR CLINICAL ASSESSMENT ……………………….. 106
ANNEX V, FIGURE I:
COMPONENTS OF THE BLUEPRINT ……………………………… 108
ANNEX VII:
GLOSSARY …………………………………………………………… 112
ANNEX VIII:
BIBLIOGRAPHY ……………………………………………………… 115
ANNEX IX:
MAP OF CARICOM MEMBER COUNTRIES ………………. 117
4
LIST OF ILLUSTRATIONS
ANNEX I, TABLE I:
COMMON HEALTH PROBLEMS IN THE CARIBBEAN
ARRANGED BY AGE GROUPS AND CATEGORIES ………… 84
ANNEX III:
GUIDELINES FOR THE USE OF CORE LIST OF
NURSING SKILLS FOR ASSESSMENR OF CANDIDATES …. 102
ANNEX V, FIGURE I:
COMPONENTS OF THE BLUEPRINT …………………………. 108
ANNEX IX:
MAP OF CARICOM MEMBER COUNTRIES …………………… 117
5
ACKNOWLEDGEMENT
The Regional Nursing Body acknowledges with gratitude the assistance received from
the following organizations in developing this Blueprint:
University of Guyana
This Blueprint is dedicated to the memory of Miss Evelyn Patterson, Lecturer, Advanced
Nursing Education Unit, University of the West Indies, Mona Campus, for her excellent
contribution and untiring effort in its preparation.
INTRODUCTION
6
In all the CARICOM territories there exist certain conditions that seem to favor the
establishment of a Regional Examination for Professional Nurse Registration. These conditions
include common health problems, similar nursing education programmes, similar nursing
practice and supporting infrastructure and, above all, the need to enhance the effectiveness of the
nursing care available to the peoples of CARICOM territories.
The Regional Nursing Body, therefore, in its objectives developed in 1976, placed the
development of a Regional Examination for Professional Nurse Registration.
A feasibility study was carried during October and November 1976 and established the
fact that 13 Commonwealth Governments in the Region agreed, in principle, to a Regional
Examination for Professional Nurse Registration.
There were subsequent activities in the further development of the Project. The General
Nursing Councils met at the Ocean View Hotel, Barbados, in 1990 to develop strategies for the
implementation of the examination. The representatives identified twenty-four(24) competencies
as the scope of practice for all registered nurses awaiting to practice nursing within the
CARICOM Member states.
Under the Canadian Nurses Association (CAN) sponsorship, the Canadian International
Development Agency (CIDA) approved the funding of the Regional Nurse Registration Project
until 1985. Funding for subsequent Project activities were also provided by the Pan American
Health Organization (PAHO) and CARICOM. PAHO continues to support the Project.
The Blueprint, therefore, is the result of the activities of nurses of the Region who
attended a series of workshops between November 1980 and 1991. The philosophy, goals,
objectives, competencies and content outline of nursing and the relevant supporting sciences. It
provides a ready reference on a Regional Professional Nurse Registration Examination.
RATIONALE
The rationale for the Regional Examination for Professional Nurse Registration is to:
7
1. Establish a uniform standard of testing and evaluating nursing students for nurse registration
in the Caribbean.
2. Foster the implementation of a uniform testing policy (passing, failing and writing
examinations).
6. Benefit individual tutors and administrators in developing their competency in testing and
evaluation.
7. Facilitate the emergence of a system for reciprocal registration of nurses in the Region
8. Provide quality examinations in the Region through the cooperation of General Nursing
Councils of the Caribbean Countries.
PHILOSPHY OF NURSING
8
MAN
1. Man is a bio-psycosocial being who has basic needs which are physical, social, spiritual
and emotional.
2. The extent to which man’s needs are satisfied determines the status of his health along
the health-illness continuum.
4. Man has a right to optimum health, health care and social services for himself and his
family.
FAMILY
5. Community is made up of family units, which interact within socio-cultural, political and
economic boundaries, and the community shares common values, beliefs and practices.
HEALTH CARE
6. Health care is a priority for individuals, families and communities.
8. Health care should be accessible, acceptable and available to each individual regardless
of his/her ability to pay.
10. Health care should be provided within the resources of the community.
11. The individual shares responsibility with the health care system for the maintenance of
his health, his family’s health and that of his community.
12. Quality health care requires the participation of the community in assessing, planning,
implementing and evaluating health programmes.
NURSING
9
14. Nursing is a key element in the provision of comprehensive health care in primary,
secondary and tertiary health care settings.
15. Nursing contributes in a unique way to the delivery of health care through its caring role.
16. Nurses function independently, inter-dependently and dependently within the multi-
disciplinary health team.
NURSING EDUCATION
18. Nursing education allows for the acquisition of knowledge, skills, attitude and problem-
solving techniques necessary to assist clients in meeting their health needs.
19. Testing and evaluation skills are important in the method of assessing the competency of
the graduating professional nurse.
The purpose of the Blueprint is to provide a uniform structure from which a standard
testing instrument can be developed and used among other methods to determine eligibility of
graduates of nursing programmes to practice professional nursing in CARICOM countries.
10
OBJECTIVES OF THE BLUEPRINT
1. Provides the basis for the development of assessment tools for regional professional nurse
examinations;
4. Outlines primary, secondary and tertiary levels of nursing and health care;
9. Establishes the parameters and standards for the professional nurse exam nations.
CONCEPTUAL FRAMEWORK
There are certain biological, psychosocial, environmental and lifestyle factors which have
positive and negative effects on man’s health status and on his needs alleviation of the negative
effects of these factors on man’s health and that of his family and community, fall as a joint
effort between man and the health care system.
11
Nursing assists man and his family to promote and maintain health. Nursing also
intervenes when man and his family are unable to cope unaided with the factors affecting health
status and needs satisfaction. The goal of nursing intervention is for man and his family to
achieve self-reliance in health care.
Examples showing the use of the nursing process are included in the Blueprint. Each
example is designed to illustrate how the factors affect needs satisfaction of the individual.
Critical elements of needs interferences and the critical areas of care, using and integrated and
team approach to care, are also identified in the examples.
In developing case studies for examinations, the critical elements of needs interferences
and the critical areas of care must be considered in relation to stages of the life cycle and the
health status of the individual. Example III (page 63-69), illustrates these principles.
2. Needs
5. Nursing process
B. Nursing
12
1. Clinical nursing
Nursing process
2. Functional nursing
Profession of nursing
Administration of Nursing
Research
Teaching, Interviewing and Counselling
For testing purpose, these concepts and content areas may be treated singly, as well as in
an integrated way.
(a) assess the health care needs of individuals of all age groups and families in any health
care setting.
(b) plan health care for individuals and families within the community based
on identified and potential problems and needs;
© implement plan care to assist individuals, families and communities to cope with
actual and/or potential problems;
2. Provide safe and competent nursing care to all age groups at all levels of health in he
wellness/illness continuum in varied settings.
13
4. Communicate effectively with co-workers, individuals and families on matters related to
health care for the promotion and maintenance of optimum health.
5. Demonstrate interpersonal skills that enhance the functions of the health team
7. Demonstrate leadership ability and skill in the management of health care services.
9. Provide guidance and counseling in prevention illness and promoting health and
rehabilitation.
11. Demonstrate understanding for national policies and their implications for nursing.
12. Apply research knowledge and skills to study and/or solve nursing and health problems.
13. Maintain competence in nursing practice through continuing education and self-directed
learning.
14. Demonstrate a caring attitude in providing nursing care to individuals, families and
communities.
15. Participate in the formulation, implementation and evaluation of standards of patient care.
16. Motivate the community and its members to participate actively in the health care
delivery system.
17. Coordinate with other sectors in the provision of health care for individuals, families and
communities.
14
19. Demonstrate competence in screening individuals, families and communities with a view
to applying appropriate nursing intervention and/or initiating relevant referral.
20. Exhibit concerns for the rights of the individuals in relation to health care, within the
ethical and legal frameworks, which are congruent with rules governing the practice of
nursing.
21. Initiate change to improve the quality of nursing practice and the delivery of health care.
22. Recognize the value of participating actively in the professional organizing for the
advancement of the Profession.
23. Assume responsibility for his/her own actions within the scope of nursing practice.
24. Recognize the role and contribution of national, regional and international organizations,
and nursing personnel, in the development of nursing.
15
OUTLINE OF MAJOR CONCEPTS OF THE BLUEPRINT
For purposes of the Caribbean Blueprint, the following age groupings are identified:
Infant to Pre-School Child 1 month – 4 years
School Child 5 – 11 years
Adolescent 12 – 19 years
Young adult 20 – 44 years
Adult 45 – 64 years
Older Adult 65+ years
2. Needs
Needs are common to individuals at all stages of the life cycle. Satisfaction pf these
needs are essential for physiological and psychosocial well-being. For purposes of the
Blueprint, the needs identified are:
Physiological
Oxygen
Nutrition
Elimination
Activity, rest, comfort
Sensory stimulation
Safety and security
Sexuality
Psychosocial
Love and belonging
Trust
Self-concept
Self-esteem
Self actualization
16
3. Factors Affecting Needs Satisfaction
These are conditions that bring about a change in man’s health status. There are four
factors, namely:
Biological
Psychosocial
Environmental
Lifestyle
Health problems are conditions which result from needs interferences. For purposes of
the Blueprint, the health problems are categorized as follows (See Table I):
Congenital
Defects of structure and/or functions existing at, or appearing after birth.
Genetic
Defects of structure and/or functions existing at, or appearing after birth due to
disorders of genes/chromosomes.
Infectious/Inflammatory
The reaction of the body to toxins and invasion by micro-organisms.
Infestations
Invasion of the body by microbes and parasites.
Allergic/Immunological
Abnormal reaction of the body to the entry of foreign substances.
Neoplastic
Benign or malignant proliferation of cells.
Accident/Trauma
Damage to tissues resulting from injuries.
17
Metabolic/Nutrition/Endocrine
Changes, which result from absence, decrease/excess of hormones, enzymes and
nutrients.
Degenerative
Disturbances due to deterioration in cellular structures and functions.
Psychosocial/Psychiatric
Disturbances characterized by distorted social, emotional and/or intellectual behaviour.
Environmental
Imbalances in the environment.
Health Infrastructure
Types and availability of health and health-related services and human resources.
5. Nursing Process
1. Assessing
Take and record nursing history from individuals and significant others
Refer to medical data
Perform physical examination
Study the data collected
Interpret the findings of the data
2. Planning
Formulate nursing diagnoses
Assign priority to nursing diagnoses
Establish problem list
Specify short-term and long-term goals
Identify appropriate nursing actions
Establish outcome criteria
18
Develop written plan of care
Involve the individual, family and significant others
Review the plan of care
3. Implementing
Activate nursing care plan – promotive, preventive, restorative/curative,
rehabilitative
Coordinate care activities
Record and report responses to nursing actions
Maintain continuity of care
Refer to appropriate agency(ies)
4. Evaluating
Collect data
Compare to individual, family, community responses with expected
outcome criteria
Determine extent to which goals are achieved
Identify alterations that need to be made in nursing diagnoses, goals,
nursing actions and outcome criteria
Modify the nursing care plan accordingly
Implement the modifications
The goals, objectives, and content included in this Section form the syllabus to be tested
in the examinations.
Goal
Demonstrate knowledge of relevant concepts of the biophysical and behavioural
sciences in relation to man and his health.
a) Bio-Physical Sciences
Objectives
5) Describe the immunological response of the body and relate the role of immunity in body
defense
10) Explain the conditions, which predispose the individuals to the invasion
and multiplication of microbes and parasites.
12) Discuss the concepts and principles of nutrition and related diet therapy.
14) Describe the principles and laws, which govern storage and use of drugs.
Content Outline
20
I Broad Concepts
Growth conditions
Modes of transmission
Control measures
21
III Nutrition
IV. Pharmaco-Dynamics
Categories of drugs
Drug actions
Indication of drugs
Adverse responses to drugs
Variables influencing drug actions
Storage of drugs
Drug standards and legislation
VI. Ecology
b) Behavioural Sciences
Objectives
2. Analyze the effects of social organizations and institutions on family life in the
Caribbean.
3. Demonstrate knowledge of community dynamics and their effects on the health status of
man.
4. Recognize normal patterns of growth and development at all stages of the life cycle.
22
5. Demonstrate understanding of the interrelationships of the basic needs of man (e.g.,
Maslow)
6. Describe the developmental tasks of individuals at different stages of the life cycle (e.g.,
Erikson).
Content Outline
I. Sociology
II. Psychology
I. Broad Concepts
3. Socioeconomic
II. Psychology
23
i. Theories of Growth and Development
B. Nursing
Goals
Objectives
3. Assess the health status of the individual, groups and community, using the
epidemiological approach.
8. Discuss factors which alter the capacity of clients to satisfy physiological and
psychosocial needs (e.g., lifestyle, environmental, psychosocial, biological)
11. Discuss measures which will assist clients to cope with alterations meeting
physiological and psychosocial needs.
12. Explain the several treatment modalities used to correct needs interferences
14. Collaborate with other team members, sectors and agencies in providing care
for individuals, families and communities.
15. Coordinate with other team members, sectors and agencies in establishing
appropriate referrals of clients.
17. Establish priorities and plans for intervention with individuals, families and
communities based on analysis, community expectations, accepting standards
of practice and available resources.
18. Determine priority care for high-risk individuals and vulnerable groups.
19. Design health programmes for special groups (e.g., workers, aging and
disabled)
25
20. Plan health education programmes, which will assist individuals, families and
communities to assume responsibility for their health.
25. Assist individuals, families and communities to develop skills to cope with
and to take responsibility for their health care.
26. Execute health and family life education programmes for individuals, families
and communities.
29. Describe roles and functions of health, health-related and social organizations
and agencies in the Region.
31. Adhere to the legal and ethical standards in the practice of nursing
26
37. Identify actual and potential problems that may occur in the pre-natal intra-
natal and post-natal periods and their related management.
38. Discuss the nurses’ role in the management of clients with specific health
problems.
42. Examine results of health care for individuals, families and communities in
terms of achievement of expected outcomes.
43. Demonstrate the ability to perform safe nursing care.
I Health
27
i. Concepts of Health Primary iv. Levels of Health Care
Secondary Primary
ii. Epidemiological Approach Tertiary Secondary
Tertiary
iii. Levels of Prevention
II Growth and Development
i. Physiological
ii. Psychosocial
i. Biological
Physiological functions
ii. Psychosocial
Coping behaviour
Socio-cultural
Political
Economic
Population dynamics
iii. Environmental
Ecology
Housing
Vectors
Sanitation
iv. Lifestyle
Substance abuse
Health practices
Dietary habits
Hobbies
Religious practices
Work habits
V. Needs Alterations
Loss
Stress
Changes in body image
Pain
Sensory deprivation
Immobility
Fluid and electrolyte imbalance
Disturbed patterns of behaviour
X. Group Dynamics
Group process
Governmental
Non-governmental
Private voluntary
XVII. Pregnancy
i. Changes in family unit due to pregnancy
o Psychosocial
o Physiological
XX. Biological and psychosocial Factors Promoting and Maintaining Needs Satisfaction
Throughout the Life Cycle
3. Physiological
i. Oxygen
Circulatory status:
o Body temperature – range
o Characteristics of apex pulse rates
o Characteristics of blood pressure
Respiratory status:
o Characteristics of respiration
o Rate of breathing
o Patency of airway
ii. Nutrition
Eating patterns
Appetite
Food fads
Diet
Food hygiene and preparation
Weight
o Normal
o Underweight
o Overweight
Height
Oral health
o Dentition
o Condition of mouth, lips, teeth, breath
o Ability to masticate
iii. Elimination
Skin integrity Bladder status Bowel status
iv. Sexuality
Grooming Male/female relationships
Condition of external genitalia Pattern of menses
Family planning practices Menopause – male and female
Pubertal changes Condition of breasts
Psychosexual development Coordination
4. Psychosocial
Individual:
i. Love and Belonging
Family, spouse, peer, other relationships
Individual and family support system(s)
Ability to give and accept love
Capacity for adjustment and adaptations
ii. Trust/Security
Status of developmental tasks according to stage of life cycle
iv. Self-Actualization
Career (and other) goals and ability to achieve these
Problem-solving ability and coping with stress
v. Socio-Economic
Occupation Financial status
vi. Socio-Cultural
Beliefs and customs influencing health
Family:
i. Family Membership (include all persons/relatives household)
Name
Age
Religion
Position, role in the family
Scholl or work of each member
ii. Extended Kinship Network
Father Children Aunts/uncles
Mother Grandparents Other
iii. Living Conditions
Amount of physical space in house
Income and socio-economic level
Neighborhood life (i.e. safety, housing conditions, availability of resources)
iv. Work
Employment stability of breadwinner
Job satisfaction
o Father o Mother o Other
Work schedule (to permit family interactions)
Family budget
v. School
Educational background of parents
Academic achievement of school-age children
Behavioural conduct of school-age children
School (teacher/family relations)
vi. Recreation
Time spent in family activities together (including meals), hobbies, individual’s
outside interests of family members
Father Mother Children
Environment
o Cleanliness
Ventilation
o Adequacy
Water
o Source of supply
o Adequacy
o Safety
Electricity
o Presence
Lighting
o Adequacy
Privacy
Solid wastes
o Dry
Method of disposal
Adequacy
Wet
o Method of disposal
Sewage disposal
Vectors
o Presence
o Control
Drainage (around home)
o Effectiveness
Sanitation
o General sanitation
Telephone, radio, television
o Presence
o Programmes on radio and television and possible side effects
Newspapers
o Availability of newspapers in the home and work
Postal services
o Home delivery
o Postal collection
Roads
o Adequacy and/or accessibility
o Availability
Safety
o Floors
o Electrical outlets, plugs
o Rugs
o Handrails
o Locking devices
o Adequacy of storage, use and disposal of:
Toys
Drugs
Detergents
Insecticides
Other chemicals
Food
o Storage
o Food and milk hygiene
ii. Community
Cleanliness of streets, public facilities, etc.,
Presence of recreational facilities
Presence of parks
Air
Pollution from traffic, factories, other
Water
Type of supply
Adequacy
Safety
Housing
Types
Adequacy
Electricity
Presence of supply
Solid wastes
Dry
o Method of disposal
Wet
o Types of disposal
o Adequacy
Sewage disposal
Drainage (streets)
Effectiveness
Telephone, television, radio
Presence of radio, television, public telephones
Safety
Community
o Supervision in swimming pools
o Presence of safety railings on roads, bridges, etc.,
o Cleanliness of public conveniences, roads, pedestrian crossings, sidewalks
Industry
o Use of protective devices
o
Ecology
o Pollutants and types
6. Lifestyle
ii. Hobbies
B. Planning
Planning nursing interventions to support individual’s and family’s ability to promote and
maintain health.
C. Implementing
Interventions to promote and maintain health/basic needs achievement.
D. Evaluation
Evidence of change in health behaviour necessary to promote and maintain health.
1. Genetic Counseling
2. Physiological
i. Oxygen
Maintain body temperature
Erect posture for better chest expansion
Prevent respiratory infections
ii. Nutrition
Nutrition education and counseling to include:
Oral health practices
Appropriate nutritional requirements and food for age
Family budgeting for food
Food hygiene and preparation
Growing backyard gardens
Norms for height and weight
Maintain appropriate weight for age
iii. Elimination
Appropriate fluid, food and exercise to develop and maintain bowel
and bladder activity
v. Sensory stimulation
3. Psychosocial
i. Love and belonging
Supportive family, spouse, peer and other relationships
Developing capacity to love and accept love
iv. Self-Actualization
Achievement of career goals
Development of problems-solving ability
v. Socio-Economic
The effects of beliefs and customs on health
4. Environmental
i. Home
Appropriate housing and living conditions
Noise Sanitation
Lighting Vector control
Ventilation Food and milk
Temperature Hygiene
Safety Water availability and safety
Methods of communication
Newspaper Radio Other
Telephone Television
ii. Community
General sanitary measures or community
Cleanliness of streets
Disposal of sewage and solid wastes
Management of pollution
Cleanliness of public places, e.g., restaurants, etc.
5. Lifestyle
Developing appropriate health habits
Work habits
Leisure time activities
Use of substances, e.g. alcohol, drugs, tobacco etc.
Developing hobbies
6. Community Resources
Availability of resources to promote and maintain health
Example I Gastro-enteritis
Age 1 ½ years
EXAMPLE I
FACTOR: GASTRO ENTERITIS (1 ½ YEARS)
A. Assessing
1. Physiological
i. Oxygen
Color
Breathing patterns
Vital signs
Cough
ii. Nutrition
Nutritional status (growth chart)
Hydration
Diet
iii. Elimination
Frequency, consistency, quantity, color of:
Vomitus
Stools
Urine
iv. Sexuality
Psychosexual development
ii. Trust
iii. Self-Esteem
iv. Self-Actualization
Effects of illness and hospitalization on child and family
Parent/child relationships
Position of child in the family
v. Socio-Economics
Family’s belief about illness
vi. Economics
Family finances
3. Environmental
Ecology
Housing and living conditions
Sanitation
Vectors
Water
Food and milk hygiene
4. Lifestyle
Family life patterns and effects on child
B. Planning
1. Nursing diagnoses
2. Problem list – actual and potential problems
3. Critical areas of care and expected outcomes
4. Required resources
5. Team approach
C. Implementing
1. Physiological
i. Oxygen
- Check color
- Monitor vital signs
- Ensure clear airway
- Administer oxygen
ii. Nutrition
- Analyze results of growth chart
- Rehydrate
- Provide adequate diet
- Monitor weight for age
iii. Elimination
- Monitor and record intake and output
v. Sensory Stimulation
- Provide play opportunities
- Provide visual and tactile stimulation
vi. Sexuality
- Observe level of psychosocial development
2. Psychosocial
Foster relationships between:
Parent/child
Nurses/child and family
Child/child
Significant others
3. Environmental
Foster environmental hygiene
4. Lifestyle
Advise on changes/modifications in family’s lifestyle if necessary
5. Health Teaching/Counselling to Family on:
Teach/counsel family about gastro-enteritis in relation to:
o Condition of gastro-enteritis
o Causes
o Prevention
o Management
o Coping skills
o Availability of resources
o Follow-up
o Family budgeting
6. Community Resources
Referrals
Coordination and continuity of care
Follow-up
D. Evaluating
EXAMPLE II
FACTOR: LEARNING DISABILITIES (10 YEARS)
A. Assessing
1. Physiological
i. Oxygen
Color
Vital signs
ii. Nutrition
Nutritional status (growth chart)
Diet
Weight
Height
Types of foods eaten and their additives
iii. Elimination
Bowel patterns
Bed wetting
iv. Sexuality
Peer group relationships
Sibling relationships
2. Psychosocial
ii. Trust
Relationships of child to:
Parents
Siblings
Teachers
Peers
Significant others
iii. Self-Concept
iv. Self-Esteem
v. Self-Actualization
Achievement of developmental tasks
Industry
Ambivalence
Independence
vi. Soci-Cultural
Child-rearing practices
Education/school system
Parental expectations
Expectations of the school; system
Family’s cultural beliefs and customs
vii. Economics
Family budget
3. Environmental
Housing
Living conditions
Overcrowding
Basic sanitation
Vectors
Stimulation in the home
Supervision in the home
Water and food hygiene
4. Lifestyle
Family’s lifestyle:
Religious practices
Eating, drinking patterns
Ability to cop with problems
Dress patterns of family and child
Family spacing
Recreational activities
B. Planning
1. Nursing diagnoses
2. Problem list – actual and potential problems
3. Critical areas of care and expected outcomes
4. Required resources
5. Team approach
C. Implementing
1. Physiological
i. Oxygen
ii. Nutrition
Advise on diet for age
Advise on preparation and eating of nutritious meals
Monitor weight and height
iii. Elimination
- Encourage child to develop good bowel and urinary habits
iv. Sexuality
- Monitor levels of psychosexual development
2. Psychosocial
iv. Self-Esteem
- assist child to understand and accept his disability
v. Self-Actualization
- establish goals achievable by child
- facilitate goal achievement
- reinforce successes
- encourage family’s recognition and acceptance of child’s level of
achievement
- implement behaviour modification programmes if necessary
3. Environmental
- counsel family
- sanitation of home including vector control
- basic living and housing conditions
- problems of overcrowding
- structured and stimulating home environment
- refer if necessary to social agencies regarding housing and living
conditions
4. Lifestyle
- encourage family spacing if necessary
- counsel on family’s lifestyle
- encourage hobbies within child’s capabilities, family’s preferences and
resources
5. Health Teaching/Counselling
- child’s relationships with others
- expected level of achievement within child’s capabilities
- nutrition
- immunization
- importance of family support and involvement in child’s education
- measures to reinforce child’s achievements
- methods of establishing achievable goals with child, teachers and
others
- importance of continuity of prescribed programmes
- techniques of developing parent-support groups in the community
- genetic counseling
- assist family to develop appropriate coping skills
6. Community Resources
- provide information on community resources
- referral to school psychologist, social worker, etc., if necessary follow-
up
D. Evaluating
1. Achievement of expected outcomes
2. Alleviation of problems.
EXAMPLE III
FACTOR: PREGNANCY (13 YEARS)
A. Assessing
1. Physiological
i. Oxygen
- respiration
- vital signs
ii. Nutrition
- dietary habits
- types of food
- idiosyncrasies
- weight, height
- morning sickness, nausea, vomiting
iii. Elimination
- diaphoresis
- frequency, dysuria, output
- bowel habits
iv. Sexuality
- menstrual history
- breast changes
- sexual intercourse
- vaginal discharge
- enlarged uterus
- knowledge of health and family life education
- male/female relationships
3. Environmental
- adequate housing and living conditions
- need for privacy
4. Lifestyle
- smoking
- substances abuse
- family life patterns and effects
- hobbies
B. Planning
1. Nursing diagnoses
2. Problem list – actual and potential problems
3. Critical areas of care and expected outcomes
4. Required resources
5. Team Approach
Actual Problems
Psychosocial Physical
Potential Problems
Psychosocial Physical
Withdrawal elevated blood pressure
Tearfulness proteinuria
Aggressiveness headache
Anxiety hemorrhage
Rejection abortion
Insomnia
Oedema
Weight gain: excessive
None
C. Implementing
1. Physiological
i. Oxygen
- monitor rate and depth of respiration
- monitor degree of dyspnoea on exertion and at rest
- monitor vital signs including foetal heart rate
- teach breathing exercises for labor
ii. Nutrition
- advise dietary measures t correct iron deficiency anemia
- monitor weight gain
- monitor dental health, refer to dentist
iii. Elimination
- test urine
- advise on dietary management of constipation
- check for odema/fluid retention
iv. Sexuality
- counsel regarding sexual practices
- assist, under supervision of midwife, with monitoring foetal growth
- physical assessment of client
2. Psychosocial
i. Love and Belonging
ii. Trust
- encourage family acceptance of pregnancy
- encourage other social relationships
iii. Self-Concept
iv. Self-Esteem
- encourage adolescent to accept pregnancy
- encourage adolescent to participate in, and accept responsibility for,
care during and after pregnancy
- provide for privacy
3. Environmental
- foster environmental sanitation
- control environmental hazards
4. Lifestyle
- modify as necessary
- develop and foster hobbies
- encourage plans to continue education
5. Health Teaching/Counselling
- pregnancy and birth process
- family life education
- family budget
- resolution of conflicts
- family communication
- sexuality
- care of baby
- preparation for parenthood
- nutrition
- exercise
- care of breasts
6. Community Resources
- refer to social agencies
- provide for financial assistance
- refer to maternity clinic
- coordination and continuity of care
- follow-up
D. Evaluating
EXAMPLE IV
FACTOR: HYSTERECTOMY (FIBROMYOMA OF UTERUS) (39 YEARS)
A. Assessing
1. Physiological
i. Oxygen
- vital signs
- pallor
ii. Nutrition
- nutritional status
- weight
- dental health
- appetite
- hydration
iii. Elimination
- urinary output
- dysuria
- frequency of micturition
- bowel habits
iv. Sexuality
- abnormal vaginal bleeding
- obstetrical history
- sexual history
- family planning practices
- abdominal enlargement
- loss of fertility
2. Psychosocial
ii. Trust
- wife/husband relationship
- family relationships
iii. Self-Concept
- knowledge of condition, required surgery and implications
iv. Self-Esteem
- body image
v. Self-Actualization
- job satisfaction
- community involvement
vi. Socio-Cultural
- husband and family knowledge of the condition and implications of
the intervention
vii. Economic
- family finances
- health and hospitalization insurances
3. Environmental
- housing and living conditions
- basic sanitation
4. Lifestyle
- substances abuse
- occupation
- hobbies
B. Planning
1. Nursing diagnoses
2. Problem list – actual and potential problems
3. Critical areas of care and expected outcomes
4. Required resources
5. Team approach
C. Implementing
1. Physiological
i. Oxygen
- monitor vital signs
- ensure clear airway
- assist with breathing exercises
- administer blood transfusion as ordered
ii. Nutrition
- maintain adequate nutrition: diet
intravenous infusion
iii. Elimination
- maintain and record intake and output
- monitor urinary drainage
- give catheter care
- ensure bowel activity
v. Sensory Stimulation
- Create stimulating environment
- Reduce painful stimuli
vi. Sexuality
- counsel wife and husband on implication of loss of uterus
- observe for changing moods and needs
2. Psychosocial
ii. Trust
- encourage acceptance of condition
- encourage family participation in care
iii. Self-Concept
iv. Self-Esteem
v. Self-Actualization
- provide for occupational therapy
- encourage self-care
vi. Socio-Cultural
3. Environmental
- modify living conditions
4. Lifestyle
- modify as necessary
5. Health Teaching/Counselling
- give instructions for discharge
- do anticipatory teaching: menopause
sexual function
activities
6. Community Resources
- arrange for referrals
- coordination and continuity of care
- follow-up
D. Evaluating
EXAMPLE V
FACTOR: HYPERACTIVE BEHAVIOUR (ANXIETY NEUROSES) (35 YEARS)
A. Assessing
1. Physiological
i. Oxygen
- vital signs
- breathing pattern
- pulse rate
ii. Nutrition
- appetite
- food fads
- idiosyncrasies
- pica
- weight
iii. Elimination
- bowel patter – frequency
- voiding pattern – frequency
- diaphoresis
iv. Sexuality
- sexual pattern and practice
- body image
- role identity
2. Psychosocial
ii. Trust
- family history
- recent changes, loss/grief, separation
- family dynamics/relationships
- spousal relationships
- child/parent relationships
- in-law relationships
- sibling relationships
- significant others relationships
- peer group/work relationships
- acceptance of others (e.g., minority groups)
iii. Self-Concept
iv. Self-Esteem
- self-acceptance
- ambivalence – self and others
- mood swings
- self-reliance, self sufficiency
- guilt, doubts, fears, obsessions
- acceptance by others
- usual coping patterns
- problems with law enforcement officers
v. Self-Actualization
- social and community development
- life’s goals/philosophy
- religious and political concerns
3. Environmental
- ecology
- residence facilities
o housing
o lighting
o water
o sanitation
o companionship
4. Lifestyle
- relation with social/ethnic groups
- customs
- values
- beliefs
- income/income source
- s[ending pattern
- use of patent medicines
- substance abuse
- occupation and job changes
- leisure/recreational activities
B. Planning
1. Nursing diagnoses
2. Problem list – actual and potential problems
3. Critical areas of care and expected outcomes
4. Required resources
5. Team approach
C. Implementing
1. Physiological
i. Oxygen
- monitor vital signs
ii. Nutrition
- encourage food intake
- offer small, attractive meals
- monitor weight gain
iii. Elimination
- encourage regular bowel activity
- monitor urinary output
iv. Sexuality
- monitor interest in appearance
2. Psychosocial
i. Love and Belonging
- establish helping nurse/patient relationships
- therapeutic communication; process recording
- observe response to therapy
ii. Trust
- encourage development of trust
- encourage acceptance of behaviour
- adopt non-judgmental attitude
- document and report all observations
iii. Self-Concept
iv. Self-Esteem
- assist client to face realities
- support improvement in self-confidence
v. Self-Actualization
- develop therapeutic milieu
- encourage occupational and group therapy
- encourage diversional therapy – games, music, etc.,
- provide behaviour therapy
- provide psychotherapy
- support employment efforts
3. Environmental
- modify environment where necessary
- refer to social services
4. Lifestyle associations
- modify to ensure meaningful
-
5. Health Teaching/Counselling
educate patient and family in relation to:
6. Community Resources
- referral services
- coordination and continuity of care
- follow-up
D. Evaluating
A. Assessing
1. Biographic Data
- family history
2. Physiological
i. Oxygen
- peripheral circulation
- vital signs
ii. Nutrition
- weight
- fluid intake
- appetite
- dietary practices
- hydration
- dental health
iii. Elimination
- glycosuria
- voiding pattern
- urine volume
- bowel habits
- attraction of ants to urine
v. Sensory Stimulation
- sensorium
- visual acuity
- tactile sensation
vi. Sexuality
- pruritis
- sexual activities
- body image
i. Self-Concept
ii. Self-Esteem
- body image
iv. Self-Actualization
v. Family Income
4. Environmental
- occupational hazards
- housing and living conditions
- hazards in the environment
5. Lifestyle
- smoking habits
- substance abuse
- sporting and recreational activities
- occupation
B. Planning
1. Nursing diagnoses
2. Problem list – actual and potential problems
3. Critical areas of care and expected outcomes
4. Required resources
5. Team approach
C. Implementing
1. Physiological
i. Oxygen
- monitor vital signs
- monitor peripheral circulation
ii. Nutrition
- advise on:
- dietary management
- food exchanges
- required calories
- meal distribution
iii. Elimination
- urinalysis
- monitor urine volume
v. Sensory Stimulation
- manipulate environment
vi. Sexuality
- advise on genital hygiene
2. Psychosocial
ii. Trust
iii. Self-Concept
iv. Self-Esteem
- encourage family participation in care
- encourage involvement in community affairs
- suggest types of diversional therapies
- suggest sources for financial assistance if necessary
v. Self-Actualization
3. Environmental
- control environmental hazards
4. Lifestyle
- modify lifestyle as necessary
- develop new recreational interests
- limit drug, alcohol and tobacco consumption
5. Health Teaching/Counselling
- condition and complications
- management to foster self-care and self-reliance
- urine testing
- dietary therapy
- drug therapy
- care of feet, eyes, nails and skin
- exercise
- sexuality
- prevention of infection
- importance of follow-up
- travel
- eating out
- blood sugar monitoring
6. Community Resources
(e.g., Diabetic Clinics and Associations)
- referral services
- coordination and continuity of care
- follow-up
D. Evaluating
EXAMPLE VII
FACTOR: SENILITY (80+ YEARS)
A. Assessing
1. Physiological
i. Oxygen
- breathing patters
- vital sogns
- history of cardiovascular and respiratory problems
- cough
- sputum
- peripheral
ii. Nutrition
- condition of teeth
- dental health
- diet
- food preferences
- fluid intake and preferences
- weight
- swallowing
iii. Elimination
- bowel pattern
- voiding pattern
- continence
- perspiration
iv. Sexuality
- sexual need
2. Psychosocial
ii. Trust
- family support
- significant others’ support
- interaction with family and others
iii. Self-Concept
iv. Self-Esteem
v. Self-Actualization
- ability for self-care
- acceptance of readiness for death
3. Environmental
- housing and living conditions
- environmental hazards
- basic sanitation
4. Lifestyle
- concept of disengagement
- recreation
- hobbies
- occupational activities
- participation in community activities
B. Planning
1. Nursing diagnoses
2. Problem list – actual and potential problems
3. Critical areas of care and expected outcomes
4. Required resources
5. Team approach
C. Implementing
1. Physiological
i. Oxygen
- monitor effects of activity on cardiovascular and pulmonary systems
ii. Nutrition
- advise on good dental health
- ensure provision and eating of nutritious foods
- stimulate appetite by various measures
iii. Elimination
- ensure bowel regularity
- measures to cope with incontinence
iv. Sexuality
- encourage peer association
- encourage hair and nail care and attractive dressing
vi Sensory Stimulation
- reality reorientation
- assist with provision of prosthesis
- assist with development of stimulating environment
2. Psychosocial
ii. Trust
iii. Self-Concept
iv. Self-Esteem
v. Self-Actualization
- involve client in planning activities
- counsel on preparation for death
vi. Socio-Cultural
- monitor effects of cultural beliefs about aging on clients welfare
vii. Economics
- ensure financial assistance and legal aid
3. Environmental
- ensure safe environment
- create a home-like environment
4. Lifestyle
- develop new hobbies/activities
5. Health Teaching/Counselling
- nutrition
- hygiene
- dental health
- activity/exercise
- accident prevention
- leisure time
- maintenance of independence
- sexuality
- economic situation
6. Community Resource
- referral services
- coordination and continuity of care
- follow-up
D. Evaluating
On the other hand, the essay-type items will test all levels of the cognitive and affective
taxonomies, but in these terms emphasis will be placed on application, analysis, synthesis and
evaluation skills of the candidate.
Weighting of Papers
The above weightings define the parameters and standards for the professional nurse
examination at the beginning level of practice.
Final weighting of each section of the Regional Examination will be at the dissection of
the RGNCs, to be decided on at each annual meeting. However, the suggested weightings are:
It is further suggested that the essay-type items be weighted no higher than 50% of the total
examination.
Scoring
The Regional Examination will define, for each examination paper, a minimum score below
a nurse’s practice is at risk. Each Member Country, however, will reserve the right to decide
on the registration criteria based on its GNC Regulations.
The examinations will also produce for each candidate a set of scores to describe hi/her
performance.
The following weightings for various components of the Blueprint document will be used:
1. Types and Levels of Nursing Skills
Cognitive
Knowledge 25 )
Comprehension 35 ) 100%
Application 40 ) 25)
Analysis 35)
Synthesis 20) 100%
Evaluation 20)
Both the affective and psychomotor domains will be reflected in the written
examination. Essay-type questions will test at all levels of the affective
domain. Only the cognitive component of the psychomotor domain will be
tested in the written examination.
Nursing Competencies
Clinical Nursing
The Nursing Process:
Assessing 30%
Planning 25%
Implementing 25%
Evaluating 20%
Functional Nursing:
The Profession of Nursing 30%
Administration/management 30%
Research 10%
Teaching, Interviewing and
Counselling 30%
Infectious/inflammatory
Neoplastic
Accident/trauma
Degenerative
Psychosocial/psychiatric
Environmental
Congenital
Genetic
Infestations
Allergic/immunological
A minimum number of items will test the candidates’ knowledge and understanding of
the health infrastructure of the Region
In preparing essay-type items, the writer will include aspects of primary, secondary and
tertiary levels of health. As well as primary, secondary and tertiary levels of health care.
Each age group will receive equal weighting since it is necessary for a professional nurse
to be acknowledgeable in all areas.
Needs
The examination will deal with all the needs, since they are common to individuals at all
stages of the life cycle.
3. The examination will deal with all areas of Nursing as outlined below:
Health
Growth and Development
Needs and their Satisfaction
Factors Affecting Needs Satisfaction
Needs Alterations
Indicators of Community Health
High-risk Individuals and Groups, including Emergencies
High Programmes for Special Groups
Health and Family Life Education
Family Unit
Pregnancy
Under Functional Nursing, the most emphasis will be placed on the Profession of Nursing
and Administration/Management.
The content related to Man and His Environment will be integrated into the
nursing content. However, no more than 30 percent of all the items will reflect the
content of man and His Environment.
TEST ITEMS
Pre-Testing of Items
1. Specific objectives will be retained for five (5) years, reviewed and updated as
necessary.
2. Test Items will be used for one examination, stored, review and made available for
reuse after two years.
3. Examination papers (scripts) will be retained by each GNC for five (5) years and then
destroyed.
TABLE 1
COMMON HEALTH PROBLEMS IN THE CARIBBEAN
ARRANGED
BY AGE GROUPS AND CATEGORIES
pyloric stenosis
Hurschsprungs
imperforate anus
Talipes
hydrocephalus
spina bilula
heart conditions
CATEGORIES AGE GROUPS
Birth - 4 years 5 - 11 years 12 - 19 years 20 - 44 years 45 - 64 years 65+ years
Congenital /Genetic Meningoceole
(cont=d)
Cataract
Down’s syndrome
Sickle cell anemia
genito-urinary malformations
physical disabilities
Infectious/ umblical infections eye infections
Inflammatory upper respiratory
tract infections
broncho pneumonia
bronchiolitis
diarrheal diseases
tetanus
HIV+
skin disorders
communicable diseases
dental health
rheumatic fever
Meningitis
Osteomyelitis
acute
glomerulonephritis
AGE GROUPS
CATEGORIES
Birth - 4 years 5 - 11 years 12 - 19 years 20 - 44 years 45 - 64 years 65+ years
AGE GROUP
CATEGORIES
Birth - 4 years 5 - 11 years 12 - 19 years 20 - 44 years 45 - 64 years 65+ years
Allergic/ eczema
Immunological
(cont=d)
Nephritic syndrome
hay fever
Anaphylactic shock
serum
sickness
Systemic lupus
erythematous
Rheumatoid
arthritis
polyarthritis
polyarteritus
nodosa
sexually transmitted
diseases
urinary tract
infections
pelvic inflammatory
disease
appendicitis
pulmonary
tuberculosis
AGE GROUP
CATEGORIES
Birth - 4 years 5 - 11 years 12 - 19 years 20 - 44 years 45 -64 years 65+ years
Neoplastic polycythemia
(cont=d) vera
benign prostatic
hyprotrophy
cancer of:
penis
tongue
lungs
colon
larynx and
oesophagus
prostate
Degenerative hernias
visual defects
hearing defects
transient
ischaemia
hypertension
peptic ulcer
myocardial
infraction
renal
calculi
varicosities
aneurysms
emphysema
urinary
incontience
osteo-arthritis
parkinson’s disease
CATEGORIES AGE GROUP
Birth - 4 years 5 - 11 years 12 - 19 years 20 - 44 years 45 - 64 years 65+ years
Degenerative cirrhosis of the liver
(cont=d) arteriosclerosis
glaucoma
cataract
cerebrovascular disease
congestive cardiac
failure
osteoporosis
Metabolic/ protein calorie
Nutritional/ malnutrition
Endocrine
failure to thrive
inborn error of
metabolism
anaemias
vitamin
deficiencies
malabsorption
syndrome
ANNEX II
TABLE II
Oxygen
4. Suction patient
6. Collect specimens
$ sputum
$ nasal swab
$ throat swab
7. Perform cardiopulmonary resuscitation
$ thoracentesis
$ bone marrow aspiration
$ tracheostomony
$ underwater seal drainage
$ nebulization
Nutrition
$ regular
$ special diets
11. Feed helpless patients
12. Feed infants and preschoolers
Elimination
$ supra-pubic catheter
$ indwelling uretheral catheter
$ condom drainage
$ other
Sensory Stimulation
$ oral
$ intradermal
$ hypodermic
$ intramuscular
41. Store drugs
42. Care for wound:
$ surgical dressing
$ removal of sutures and clips
$ removal of drain packs
$ wound irrigation
43. Give bed bath
44. Give mouth care
45. Give skin and pressure care
46. Apply bandages, splints, restraints, tourniquets, other
47. Use and maintain prostheses:
$ wheelchair
$ walkers
$ canes
$ crutches
$ artificial limbs
$ other
Safety and Security
(cont=d)
48. Apply electric and electronic patient devices
$ surgery
$ bone marrow aspiration
$ paracentesis abdominis
$ lumbar puncture
$ endoscopy
Sexuality
$ planning
$ organizing
$ directing
64. Apply:
$ epidemiological approach
$ research methodology
ANNEX III
1. Continuous clinical assessment of students should be done by nursing schools throughout the educational programme, using
the approved core list of nursing skills.
3. All items included in the core list must be completed successfully before entry to the final programme examination.
4. Close supervision and teaching of students in the clinical areas must be provided.
5. Students must be made aware of their strengths and weaknesses through the use of anecdotal records.
6. Before the final programme examination, students must complete a specified number of hours of practical instructions as
determined by the General Nursing Council.
7. A standardized checklist will be used to determine the students’ proficiency in each area of skill.
8. The students’ performance of each skill must be assessed and recorded on the checklist by the person supervising the student.
10. The critical skills indicated by asterisks as outlined in the checklist denote that some steps of the nursing procedures are critical
and can endanger the life of a patient if performed inaccurately.
11. Any student who fails in performing accurately a skill(s) which is/are indicated as critical will, at the discretion of the
examiners, be asked to discontinue the assessment.
12. Students should be given further instruction for a specified period before reassessment of those skills, which were not
performed accurately.
N.B. Examples I and II provide an assessment checklist for surgical aseptic technique and an observation checklist, respectively.
ANNEX III
EXAMPLE I
ASSESSMENT CHECKLIST FOR SURGICAL ASEPTIC TECHNIQUE
Candidate No:
Candidates are expected to perform in all areas list and MUST pass in areas with as asterisk (*)
Examiners: ____________________________________
____________________________________
____________________________________
6. Comfort of patient
EXAMPLE II
OBSERVATION CHECKLIST
PROCEDURE:
OBSERVER:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
TOTAL
ANNEX IV
4. Tools for clinical evaluation, derived from the clinical objectives, must be developed
and used to assess students’ performance in the clinical areas.
5. Tools for clinical evaluation include checklists, anecdotal records, profiles, other.
8. In order to complete the clinical component of the nursing programme, the students
must be assigned to all designated areas for the specified time.
10. Clinical assignment and evaluation tools must form part of the students’ permanent
records.
11. Clinical assessment must focus on the overall care provided to one or more patients,
using the nursing process and will include the related procedures performed.
12. Clinical assessment will include assessment of the overall organization and
management ability of students, to include such areas as management of time and
resources, communication skills, etc.
ANNEX VII
GLOSSARY
For the purpose of this Blueprint, the following terms are operationally defined:
The actual and/or potential responses to need interferences that threaten the
physiological and psychosocial well-being of the individual, family and community.
4. Disabled
A person with structural and/or functional defects who is able to carry out
activities of daily living within his capacity.
5. Elderly
The term elderly in the Blueprint refers to individuals age 65 and over, and is
used synonymously with the term aging.
6. Factor
Conditions that maintain or change the health status of man. For the purpose
of the Blueprint, the following four factors are identified:
Maternity Cycle
That period from conception to six weeks post-natal. Any reference to the maternity
cycle includes care of the mother, neonate and other members of the family.
Optimum health
BIBLIOGRAPHY
6. Krathwohl, David, r., bloom, Benjamin, Masta, S., and Bertran, B. (1964).
Taxonomy of educational objectives: affective domain. New York: David McKay Co.,
Inc.