Nursing Internship Log-Book For the Bridging Program.
Transcript of Nursing Internship Log-Book For the Bridging Program.
1
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
(الامتياز)الإلزامي لتدريبا كتيب
للبرنامج التكميلي )التجسير(
Nursing Internship Log-Book
For the Bridging Program.
First Edition - 1437 H (2015 G)
Name of Nurse Intern ………………………………………………………..
Date Started (from) ………………… Date completes (To) ……………
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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
Dr. Waleed H Mahallawi
Assistant Professor of Medical Immunology
Vice Dean for Quality and Hospitals Affairs
Approved by:
Dr. Omar M. Al Nozha
Assistant Professor of Medicine & Consultant Endocrinologist
Dean of the College of the Nursing
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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 clinical instructor signature in the log book 9
Attendance record form 10
Clinical skills for:
Clinical skills for the basic nursing care 11
Clinical Skills for Medical Department. 12
o Clinical Skills for Dialysis Unit 15
Clinical Skills for Surgical Department. 17
Clinical Skills for Operation Room. 20
Clinical Skills for Emergency Department. 22
Clinical Skills for Intensive Care Unit. 24
Clinical Skills for Pediatric Department 26
Clinical Skills for Maternity and Obstetric Department. 28
Clinical Skills for Labour Room. 30
Clinical Skills for Primary Health Care Center. 32
Clinical Skills for Psychiatry Department. 34
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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
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
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
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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
(including of 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
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Internship Training Period.
All interns in bridging program are expected to work 40 hours a week in a total of 26
weeks.
Internship Clinical Rotations (Time Distribution) for the Bridging Program.
Main Departments
Number of
weeks Specific Areas
Number of
weeks
Girls Boys Girls Boys
Medical Department 4 4 Medical department 3 3
Hemodialysis (HD) 1 1
Surgical Department 2 4 Surgical department 2 4
Operation Room (OR) 2 2 OR 2 2
Emergency Department (ED) 2 4 ED 2 4
Intensive Care Unit (ICU) 2 4 ICU 2 4
Psychiatric Department 4 4
Inpatient department 2 2
Emergency department 1 1
OPD 1 1
Primary Health Care Center 2 2 Vaccination room 1 1
OPD 1 1
Pediatric Department 4 2 Pediatric department 4 2
Obstetrics & Gynecology 4 ------ Maternity & Obstetric 2 ------
Labour Room 2 ------
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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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Example for the Clinical Instructor Signature in the Log Book
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
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 the 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)
Utilizes 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.
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
- 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:
Calculation of 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 collection.
Stool sample.
Assisting with Safe Preparation and Post Procedure Care for the following Procedures:
CT Scan/MRI.
Endoscope/Bronchoscope.
Extracorporeal shock wave lithotripsy (ESWL)
Prepare Patient and Equipment and Assist with:
Lumbar puncture
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
Bone marrow puncture
Thoracentesis
Paracentesis
Liver biopsy and liver abscess aspiration.
Prepare and Perform the following Procedures:
Gastric tube (inserts, care, and remove).
Gastric wash/lavage.
Bolus enteral tube feeding.
Recording the 12-leads ECG.
Monitors blood sugar by gulco-check machine.
Indwelling urinary catheter (insert, care, & remove).
Condom catheter to male patient.
Urine screening for sugar, albumin, acetone.
Bed making (unoccupied/occupied)
Name Signature Date
Clinical Instructor
Head Nurse/Charge Nurse
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Hemodialysis Unit (Artificial Kidney Unit)
Period of rotation: From _______________________ To _______________
No. of days absent with leave _____________ without leave__________
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.
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
Basic nursing care skills (refer to page 11)
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.
Initiates dialysis with internal vascular access/with CVC
Collect Blood Specimens
Care and Monitor the Patient and Equipment During Hemodialysis.
Systemic assessment of patient and the patient
subjective response to treatment.
Monitor volume status.
Assess vascular access function.
Monitor the arterial and venous pressures and the
blood flow rate.
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
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.
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
Name Signature Date
Clinical Instructor
Head Nurse/Charge Nurse
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Surgical 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 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.
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)
Safely lifting a patient:
Bed to chair/chair to bed.
Trolley to bed/bed to trolley.
Transporting patients on a stretcher and in wheel chair
Insert, maintain & remove the peripheral IV cannula.
Apply the external heating/cooling device (use of
hyper/hypothermia blanket).
Perform blood and blood products transfusion.
Preoperative Management.
Organize chest x-rays, ECG, blood work and check
pre-operative checklist.
Teach patient and prepare the patient’s skin.
Prepare and administer the enema.
Transfer patients to OR and from recovery room.
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وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
Post-Operative Management
Receive the patient from OR, position the patient in
bed and 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.
Wound Care and Surgical Dressing.
Setup of sterile surgical field, add the supplies and
pour solution aseptically.
Change surgical dressing aseptically.
Cleanse, irrigate, pack, and dress the open wound.
Monitor and care of drains/hemovac devices.
Remove sutures and staples.
Care and change dressing for diabetic foot.
Irrigate the 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/continuous
closed bladder irrigation
Provide the care of nephrostomy tube
Prepare & assist with suprapubic catheter insertion
Provide the care of the suprapubic catheter.
Orthopedic and Care of Tractions
Prepare patient for traction application
19
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
Maintain and care of traction (skin and skeletal)
Provide the pin care.
Prepare materials and patient for cast application.
Provide plaster cast care & after cast removal care
Assisting with 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 )
I.V.P. / Excretory urography
Name Signature Date
Clinical Instructor
Head Nurse/Charge Nurse
20
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Operation Room Period of rotation: From _______________________ To _______________
No. of days absent with leave _____________ without leave__________
Attendance: a) Regular / Irregular b) Punctuality – Yes / No
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)
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)
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.
21
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
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
Clinical Instructor
Head Nurse/Charge Nurse
22
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Emergency Department (ED) Period of rotation: From _______________________ To _______________
No. of days absent with leave _____________ without leave__________
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.
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)
Check crash cart contents, test the defibrillator safely,
and accurately reporting any discrepancies.
Perform emergency primary assessment (ABCDE)
Perform emergency secondary assessment.
Perform triaging: able to demonstrate & assist in
prioritizing patients management
Perform BLS procedures
Provide bag-valve-mask ventilation
Participate in ACLS and administer the ACLS drugs
Prepare and assist with defibrillation/cardioversion.
Insert the nasopharyngeal and oropharyngeal airway.
Prepare and assist with the tracheal intubation.
Prepare and assist with the tracheostomy.
Perform naso- and oro- pharyngeal suctioning.
Insert the peripheral IV catheter, withdraw blood
sample and provide the IV fluid resuscitation.
23
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
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
Apply pulse oximetry to the patient
Provide O2 therapy by simple face mask, venturi
Mask, and by nasal cannula.
Prepare patient, equipment, and chest drainage system
(Pleurevac drainage) & assist with chest tube insertion
Prepare patient and equipment, and assist with
pericardiocentesis.
Administer medication by inhalers and nebulizer.
Administer common emergency medications.
Administer the thrombolytic therapy.
Prepare and assist with esophagogastric Tamponade
Tube insertion (Sengstaken-Blakemore tube).
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 and
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
Clinical Instructor
Head Nurse/Charge Nurse
24
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Intensive Care Unit Period of rotation: From _______________________ To _______________
No. of days absent with leave _____________ without leave__________
Attendance: a) Regular / Irregular. b) Punctuality – Yes / No.
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 other colleagues.
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)
Set up ventilator, adjust the ventilator setting as
prescribed and test the alarm system.
Provide the care of mechanically ventilated patient.
Trouble shooting the ventilator alarms.
Perform endotracheal tube care (changing position,
changing the tie and fixation)
Perform tracheostomy and tracheostomy tube care.
Perform ETT/tracheostomy tube suctioning.
Collect sputum sample by suction.
Perform extubation according to physician order.
Perform chest physiotherapy.
Provide O2 therapy by tracheotomy mask/trach
collar and T-piece
Prepare and assist with insertion and set up of:
Arterial line
25
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
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
Set up cardiac monitor, adjust and test the alarm
system and initiate the cardiac monitoring.
Use IV infusion pumps and IV syringe pumps
Administer continuous enteral feeding by pump
Administer TPN, PPN and lipids.
Provide perineal care
Provide eye care
Provide oral care
Provide hair care
Provide complete/partial bed bath.
Name Signature Date
Clinical Instructor
Head Nurse/Charge Nurse
26
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Pediatric 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 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.
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)
Take health history and perform complete pediatric
physical assessment.
Assess infant/child growth & development:
Weight and height.
Head, chest and abdominal circumference.
Record on growth graph.
Measure & document vital signs.
Pulse, respiration, and B.P.
Temperature: axillary and rectal by glass and
electronic thermometer, and by tympanic probe.
Apply the pulse oximeter to the neonate, infant and child
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 and provide the care of
IV Heplock/cannula and cannula flashing.
27
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
Prim & regulate the flow rate of IV fluids.
Calculate the pediatric medication dosage
Prepare and administer medications (oral, SC, IV & IM).
Administer medication by nebulizer/inhaler
Prepare and administer the ORS.
Prepare and provide bottle feeding.
Insert, care, and remove gastric tube.
Prepare and administer feeding through the gastric tube
and gastrostomy.
Administer TPN/PPN.
Provide the phototherapy.
Use radiant warmer.
Perform chest physiotherapy.
Perform passive exercise/guide the child for active exercise
Perform the paediatric/neonate hygiene
Complete/partial bath.
Diaper care.
Make up a bed/cot, use the bedrails and restraints
appropriately 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 patient for discharge (give patient & parents health
teaching about appointments, medications, diet & any
special instruction)
Name Signature Date
Clinical Instructor
Head Nurse/Charge Nurse
28
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Maternity/Obstetric Department (for female nurse interns)
Period of rotation: From _______________________ To _______________
No. of days absent with leave _____________ without leave__________
Attendance: a) Regular / Irregular. b) Punctuality – Yes / No.
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. Provide antenatal and postnatal health education regarding breast feeding, schedule
of immunization, family planning methods, nutrition and exercise.
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) Antenatal. Obtain the estimated date of delivery and the OB history.
Perform physical examination of pregnant patient/
obstetric examination.
Perform breast examination
Perform Leopold's maneuvers (abd. maneuver)
Assist with pelvic examination during pregnancy.
Auscultate & record fetal heart rate using Pinard
stethoscope & doppler
Test urine for protein & sugar using urinary dipstick.
Assist with non-stress test (NST)
Perform the external cardiotocography (CTG):
Set–up the and apply CTG machine
Monitor contraction and fetal heart rate
Interpret CTG reading & reporting abnormalities.
29
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
Assist with self-care, breast care, and perineal care.
Observe & recognize blood loss through vagina (P.V loss)
Assist with Prostin vaginal tablets insertion.
Prepare patient for CS (preoperative care)
Post-Natal.
Administer of oxytocin injection and infusion as prescribed
Perform postpartum assessment:
Vital signs and pain level
Examine the abdomen and fundal height
Perineum condition, lochia and assess for vaginal
bleeding/perform the pad measurement
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 postpartum health education about the:
Routine newborn care & hygiene
Breast care and establishment of breast feeding
Post-natal exercise
Milk Formula’s: types & rationale, preparation, and
sterilization of bottles & teats
Immunization schedule
Name Signature Date
Clinical Instructor
Head Nurse/Charge Nurse
30
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Labour Room (for female nurse interns)
Period of rotation: From _______________________ To _______________
No. of days absent with leave _____________ without leave__________
Attendance: a) Regular / Irregular. b) Punctuality – Yes / No.
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.
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 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.
Assist with normal vaginal delivery
31
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
Assist with episiotomy & repair
Prepare patient for emergency caesarian section
Administer the drugs (Syntocinon and Methergin)
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.
Filling in the birth register and the obstetrical booklet
Name Signature Date
Clinical Instructor
Head Nurse/Charge Nurse
32
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Primary Health Care
Period of rotation: From _______________________ To _______________
No. of days absent with leave _____________ without leave__________
Attendance: a) Regular / Irregular. b) Punctuality – Yes / No.
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)
Assess and Record the Vital Signs
Temperature by axillary, oral, rectal, or tympanic
Pulse: apical rate and the radial rate
Respiration
Blood pressure
Antenatal Care.
Measure the mother’s weight and height.
Measures correctly 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
Vaccination Clinic
Administer IM injection
33
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
For Infants:
- Rectus femoris (mid anterior thigh)
- Vastus lateralis (middle third thigh)
For Toddlers and school age (poster dose).
- Poster 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
Screen urine for glucose, ketones, and protein.
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
Clinical Instructor
Head Nurse/Charge Nurse
34
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Psychiatry Department Period of rotation: From _______________________ To _______________
No. of days absent with leave _____________ without leave__________
Attendance: a) Regular / Irregular. b) Punctuality – Yes / No.
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.
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).
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
Individual psychotherapy
35
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
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
Perform rapid tranquilization as prescribed.
36
وزارة التعليم
جامعة طيبةالتمريض كلية
زوحدة الامتيا
Kingdom of Saudi Arabia
Ministry of Education
Taibah University
College of Nursing
Internship Unit
Clinical Skill/Task Level of Performance Not
Applicable Satisfactory Unsatisfactory
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
Clinical Instructor
Head Nurse/Charge Nurse