THE TRAINEE’S HANDBOOK

PRACTICAL GUIDE
TO
REGISTERED GENERAL NURSING,
MIDWIFERY,
FAMILY PLANNING,
&
PSYCHIATRIC COMPETENCIES

A FOCUS ON NMC & CLINICAL

EXCELLENCE

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PREFACE
This book has been specially made handy to equip students
with the relevant knowledge and skills required to distinguish
themselves in the clinical setting. It provides a step-by-step
guide on tasks students are expected to be abreast with as
trainees.
It also enlightens trainees on some basic abbreviations within
the clinical environment that will help them be more effective
and efficient. This book is intended to promote the churning
out of confident and practically oriented students who will
excel in their examinations and become model staffs that will
help train future generations. In short, you could call it the
"trainees' handbook".

DEDICATION
This handbook is dedicated to all trainees of the
noble profession.

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Table of Contents
1.0 GENERAL NURSING PROCEDURES..................................................................7

1.1 MAKING A SIMPLE UNOCCUPIED BED..................................................................7

1.2 MAKING AN OPERATION BED.................................................................................8
1.3 MAKING A CARDIAC BED.......................................................................................10
1.4 MAKING AN ADMISSION BED................................................................................10
1.5 CHANGING BOTTOM SHEET FROM TOP TO BOTTOM.....................................11
1.6 CHANGING BOTTOM SHEET OF PATIENT FROM SIDE TO SIDE....................13
1.7 CHECKING OF VITAL SIGNS (ELECTRONIC THERMOMETER).......................14
1.8 CHECKING VITAL SIGNS-TEMPERATURE, PULSE, RESPIRATION, BLOOD
PRESSURE (USING MERCURAL THERMOMETER AND MECURIAL
SPHYGMOMANOMERTER)............................................................................................15
1.9 TEPID SPONGING......................................................................................................17
1.10 ADMISSION OF PATIENT (AMBULANT).............................................................18
1.11 ORIENTATION OF PATIENT TO WARD ENVIRONMENT (AMBULANT)......19
1.12 COLLECTION OF SPECIMEN FROM A PATIENT CONFINED TO BED...........20
1.13 DISCHARGING A PATIENT FROM THE HOSPITAL..........................................21
1.14 EDUCATING A PATIENT ON CONDITION..........................................................22
1.15 TRANSFER OF PATIENT.........................................................................................23
1.16 ASSISTED BATHROOM BATHING.......................................................................24
1.17 BED BATHING..........................................................................................................25
1.18 TREATMENT OF PRESSURE AREAS....................................................................27
1.19 ADMINISTRATION OF TABLET............................................................................28
1.20 ADMINISTRATION OF MIXTURE.........................................................................29
1.21 PREPARING TRAY AND GIVING INTRAMUSCULAR INJECTION.................31
1.22 HANDING OVER THE WARD................................................................................32
1.23 TAKING OVER A WARD.........................................................................................33
1.24 EDUCATING A PATIENT ON MEDICATION PRIOR TO DISCHARGE............34
1.25 EDUCATING A PATIENT ON MEDICATION AT HOME AFTER DISCHARGE
.............................................................................................................................................35

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 1.26 MOUTH CARE...........................................................................................................36
1.27 MOUTH CARE FOR SERIOUSLY ILL/UNCONSCIOUS PATIENT....................37
1.28 DRESSING OF WOUND (WITH ASSISTANCE)....................................................38
1.29 REMOVAL OF STITCHES.......................................................................................39
1.30 REMOVAL OF CLIPS...............................................................................................40
1.31 PROCESSING INSTRUMENTS AFTER USE.........................................................41
1.32 SPOON FEEDING OF AN ADULT ILL PATIENT.................................................42
1.33 FEEDING A HELPLESS PATIENT..........................................................................43
1.34 RECORDING INTAKE AND OUTPUT...................................................................45
1.35 EXAMINING HEAD AND HAIR.............................................................................46
1.36 WASHING OF PATIENT'S HAIR.............................................................................47
1.37 TREATING PEDICULOUS HAIR............................................................................48
1.38 SERVING A BEDPAN TO A HELPLESS PATIENT...............................................49
1.39 PREPARATION AND CARE OF PATIENT DURING AND AFTER LUMBER
PUNCTURE........................................................................................................................50
1.40 SKIN PREPARATION FOR SURGERY...................................................................52
1.41 PRE-OPERATIVE PREPARATION OF PATIENT FOR SURGERY.....................53
1.42 CARE OF HANDS AND FEET.................................................................................54
1.43 LAST OFFICES..........................................................................................................55

2.0 MIDWIFERY PROCEDURES.............................................................................57

2.1 BATHING A NEW BORN BABY AND CORD DRESSING....................................57

2.2 EXAMINING A NEW BORN BABY IN THE LABOUR WARD.............................58
2.3 ACTIVE MANAGEMENT OF THE 3RD STAGE OF LABOUR................................58
2.4 CONDUCTING ABDOMINAL EXAMINATION ON A PREGNANT CLIENT.....59
2.5 CONDUCTING 2ND STAGE OF LABOUR.................................................................60
2.6 TAKING A PAST HISTORY OF A PREGNANT CLIENT.......................................61
2.7 GENERAL EXAMINATION OF PREGNANT CLIENT AT THE ANTENAL
CLINIC................................................................................................................................62
2.8 GIVING HEALTH EDUCATION ON PERSONAL AND ENVIRONMENTAL
HYGIENE TO A PREGNANT WOMAN..........................................................................63
2.9 HELPING TO FIX AND BREASTFEED BABY........................................................64

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 2.10 GIVING HEALTH EDUCATION ON DANGER SIGNS TO A PREGNANT
CLIENT...............................................................................................................................65
2.11 TESTING THE URINE OF A PREGNANT WOMAN FOR SUGAR/PROTEIN....65
2.12 GIVING HEALTH EDUCATION ON NUTRITION TO A PREGNANT WOMAN
.............................................................................................................................................66
2.13 EXAMINING THE BREAST OF A PREGNANT CLIENT.....................................67
2.14 GIVING HEALTH EDUCATION ON BIRTH PREPAREDNESS AND
COMPLICATION READINESS PLAN TO A PREGNANT CLIENT.............................68
2.15 GIVING HEALTH EDUCATION ON PREVENTION OF MALARIA TO A
PREGNANT CLIENT........................................................................................................69
2.16 VULVAL SWABBING OF PUERPERAL CLIENT.................................................70
2.17 GIVING HAELTH EDUCATION ON EXERCISE, REST AND SLEEP TO A
PREGNANT CLIENT........................................................................................................71
2.18 VULVAL TOILETTING OF A PUERPERAL CLIENT...........................................71
2.19 EXAMINING A NEW BORN BABY IN A LYING-IN............................................72

3.0 PSYCHIATRIC NURSING PROCEDURES.........................................................73

3.1 FACILITATING COUNSELING SESSION...............................................................73

3.2 FACILITATING GROUP THERAPY SESSION........................................................74
3.3 ASSISTING THE HYPOACTIVE (DEPRESSED) PATIENT TO CLEAN THE
MOUTH..............................................................................................................................75
3.4 PREPARING PATIENT FOR OCCUPATIONAL THERAPY...................................76
3.5 ORGANIZING GROUND PAROLE...........................................................................77
3.6 ADMINISTERING TABLETS TO THE OVERACTIVE (ELATED) PATIENT......78
3.7 ASSESSING THE PSYCHIATRIC PATIENT............................................................79
3.8 INTERVIEWING THE PSYCHIATRIC PATIENT....................................................80
3.9 TUBE FEEDING THE HYPOACTIVE (DEPRESSED) PATIENT...........................81
3.10 ADMINISTERING MIXTURES TO THE OVERACTIVE PATIENT....................82
3.11 ADMINISTERING TABLET TO THE HYPOACTIVE PATIENT..........................84
3.12 TAKING HISTORY OF PSYCHIATRIC PATIENT................................................86
3.13 RESTRAINING THE AGGRESSIVE PATIENT ON THE WARD.........................87
3.14 MANAGING PATIENTS WITH INAPPROPRIATE PERCEPTION
(HALLUCINATION AND ILLUSION)............................................................................88

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 3.15 ESTABLISHING RAPPORT WITH THE PSYCHIATRIC PATIENT
(DEVELOPING INTERPERSONAL RELATIONSHIP)..................................................89
3.16 FEEDING THE HYPOACTIVE (DEPRESSED) PATIENT.....................................90
3.17 ADMINISTERING MIXTURES TO HYPOACTIVE PSYCHIATRIC PATIENT. .92
3.18 ASSISTING THE HYPOACTIVE TO BATH IN THE BATHROOM.....................93
3.19 FEEDING THE OVERACTIVE PATIENT...............................................................94
3.20 CARING FOR THE PATIENT AFTER ELECTRO-CONVULSIVE THERAPY
(ECT) IN THE WARD........................................................................................................95
3.21 PREPARING FOR SECLUSION AND CARE OF PATIENT IN SECLUSION......96
3.22 ASSISTING THE OVERACTIVE (ELATED) PATIENT TO CLEAN MOUTH....97
3.23 FACILITATING FAMILY THERAPY.....................................................................98
3.24 ORGANIZING PATIENT'S DISCHARGE.............................................................100
3.25 SHAVING OF AMPIT AND PUBIS.......................................................................101

4.0 FAMILY PLANNING...................................................................................102

4.1 GENERAL COUNSELLING FOR FAMILY PLANNING.......................................102
4.2 COUNSELLING CLIENT TO MAKE AN INFORMED CHOICE (FAMILY
PLANNING).....................................................................................................................103
4.3 COUNSELLING CLIENT ON A FAMILY PLANNING FOLLOW-UP VISIT......104
4.4 COUNSELLING AND ADMINISTRATION OF INJECTABLE CONTRACEPTIVE
TO A CLIENT...................................................................................................................105
4.5 COUNSELLING CLIENT ON NATURAL FAMILY PLANNING (NFP) METHODS
...........................................................................................................................................106
4.6 COUNSELLING CLIENT ON VOLUNTARY SURGICAL CONTRACEPTION
(VSC).................................................................................................................................107
4.7 COUNSELLING CLIENT ON SPERMICIDE..........................................................108
4.8 COUNSELLING CLIENT ON INTRAUTERINE DEVICE (IUD) AND ITS
INSERTION......................................................................................................................109
4.9 REMOVAL OF INTRAUTERINE DEVICE (IUD)..................................................111

5.0 CLINICAL ABBREVIATIONS...................................................................113

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 1.0 GENERAL NURSING PROCEDURES
1.1 MAKING A SIMPLE UNOCCUPIED BED

1. Collect, arrange items on trolley and send to bedside.

2. Arrange items in order of use on two chairs or cardiac
table.
3. Place bottom sheet evenly on the bed.
4. Tuck the sheet evenly under the mattress at the top and
bottom using enveloped corners.
5. Pull sheet tight so that there are no creases and tuck in at
the side.
6. Place draw mackintosh across the bed and cover with a
draw sheet.
7. Place the pillow on the bed so that the open ends of the
slips are always from door.
8. Place the top sheet on with the wrong side uppermost.
9. Fold over at the bottom and tuck in loosely to prevent
restriction of the patient's feet
10. Place the bed cover or counterpane loosely over the bed.

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 11. Tuck in at the bottom and under mattress using envelop
corners
12. Fold top sheet over the counterpane at the top end.
13. Tuck in all sides under the mattress.
14. Move trolley and chairs.

1.2 MAKING AN OPERATION BED

1. Collect, arrange items on trolley and sends to bedside

2. Arranges item in order to use on a chair or heart table
3. Place bottom sheet evenly on bed and tucks it under the
mattress at the bottom using enveloped corners.
4. Pull sheet tight so that there are no creases and tucks in
the sides.
5. Place draw mackintosh across bed and covers with draw
sheet.
6. Place protective dressing towel at the top of bed.
7. Leave pillow on chair by the bed.
8. Spread blanket on the bed.
9. Place top sheet on with wrong side uppermost and turn
back the bottom end.
10. Fold the top bed cloth at three open side in three parts
over the bed for easy admission of patient.

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 11. Place a post anaesthetic tray by the bed side containing
vomit bowl, dressing towel, kidney dish containing
swab holding forceps, dissecting forceps, tongue
holding forceps and spatula.
12. Arrange other bed accessories by bed side - drip stand,
bed rail and blood-pressure apparatus.

1.3 MAKING A CARDIAC BED

1. Collect, arrange items on trolley and send to bedside.

2. Arrange items in order of use on a chair or heart table.
3. Place bottom sheet evenly on the bed and tuck the sheet
under the mattress at the top and bottom using envelope
corners.
4. Pull sheet tight so that there are no creases, tuck in at the
side.
5. Place draw mackintosh across bed and cover with draw
sheet and tuck in.
6. Place back rest at top of bed and arrange pillows on it.
7. Place top sheet on bed with the wrong side uppermost
and fold sheet over at the bottom.
8. Place covered air ring on bed.
9. Place foot rest in position.
10. Place sputum mug and bell within reach of patient.
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 11. Provide pen and paper if patient is literate.

1.4 MAKING AN ADMISSION BED

1. Collect, arrange items on trolley and send to bed side.

2. Arrange items in order of use on a chair or heart table.
3. Place bottom sheet evenly on the bed.
4. Tuck the sheet evenly under the mattress at the top and
bottom using envelope corners.
5. Place draw mackintosh across bed and cover with draw
sheet.
6. Place long mackintosh on the bed.
7. Use one bath blanket or sheet over and tuck in all round
or folds under itself.
8. Place second bath blanket over the bed.
9. Put in hot water bottle if necessary.
10. Put on top bed clothes.
11. Place counterpane loosely over the top bed clothes.
12. Tuck in the bed clothes on the other side.
13. Fold the bed clothes on the other side nearest to the
door, leaving it open.

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1.5 CHANGING BOTTOM SHEET FROM TOP TO
BOTTOM

1. Establish rapport and explain procedure to patient

2. Assemble the necessary equipment and material and
provide privacy
3. Place 2 chairs at the foot end of the bed
4. Loosen sheet from all sides of the bed
5. Leave patient covered with the top sheet
6. Hold top sheet over patients shoulder with hand nearest
to head of the bed
7. Move patient to foot end of the bed with the help of an
assistant and let him lean on heart table with a pillow.
8. Support patient and remove pillows and place on chair.
9. Remove draw sheet and place it in the dirty linen bin.
10. Make top half foundation of the bed with clean sheet
and arrange pillows at the top half of the bed
11. Help patient back to position, keeping him covered.
12. Instruct assistant to lift the patient’s legs whiles she
removes the soiled bottom sheet.
13. Pull down the clean bottom and draw sheet tight and
tack in.
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 14. Complete bed making and make patient comfortable.
15. Clear items and remove screen.
16. Wash, dry hand and document any observation seen.

1.6 CHANGING BOTTOM SHEET OF PATIENT FROM

SIDE TO SIDE

1. Explain procedure to patient and ensure privacy

2. Collect and arrange items on a trolley
3. Arrange sheets in order to use on two chairs or heart
table
4. Loosen sheet at side of the bed, leave patient with only
one pillow and cover her with top sheet
5. Turn patient to one side of the bed supported by another
nurse and draw mackintosh and sheet
6. Roll dirty bottom sheet under patient
7. Cover the bed with a clean rolled bottom sheet halfway
in the middle of the bed
8. Put on draw mackintosh and draw sheet across the bed
and tuck in greater part nearest to the door
9. Remove dirty bottom sheet and place it in a receptacle.
10. Pull tight and tuck in bottom sheet.
11. Cover patient with top sheet and counterpane and leave
patient comfortable.
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 12. Clear equipment and remove screen.
13. Wash and dry hands.

1.7 CHECKING OF VITAL SIGNS (ELECTRONIC

THERMOMETER)

1. Explain procedure to patient.

2. Press knob and ensure thermometer is functioning and
wash hands.
3. Prepare and send tray to patient’s bedside.
4. Make patient comfortable by lying or sitting up in bed.
5. Press knob again to show reading on the screen, expose
axilla, dry with clean cotton wool and discard.
6. Insert thermometer into axilla between two folds leaves
it in place until it beeps.
7. Whiles thermometer is in axilla, checks and record clean
from stem to the bulb and inserts thermometer back into
its cover.
8. Record readings of temperature, pulse, respiration.
9. Record readings of temperature, pulse, respiration.
10. Stretch patient's arm and places sphygmomanometer
beside arm at the same level
11. Wound cuff around arm above elbow.

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 12. Inflate cuff, palpates radical artery and notes level of
mercury at which pulse disappears
13. Wear and replaces stethoscope on brachial artery.
14. Release pressure slowly and listens to sound with
stethoscope.
15. Remove cuff and reassembly apparatus
16. Thank patient, makes him comfortable and
communicates findings to him/her.
17. Wash and dries hands and documents findings.
18. Report to the ward in-charge.

1.8 CHECKING VITAL SIGNS-TEMPERATURE,

PULSE, RESPIRATION, BLOOD PRESSURE (USING
MERCURAL THERMOMETER AND MECURIAL
SPHYGMOMANOMERTER)

1. Explain procedure to patient and provides privacy

2. Prepare and send tray to patient’s bedside
3. Make patient comfortable by lying or sitting up in bed
4. Rinse thermometer in cold water
5. Dry thermometer with cotton wool from bulb towards
the stem
6. Shake thermometer until mercury falls below 35 degrees
Celsius

14
7. Dry axilla with clean cotton wool and discard
8. Insert thermometer in the axilla between two folds of
skin and leaves in position for 2-3 minutes
9. Whiles thermometer is in axilla, checks and records
pulse and respiration.
10. Remove thermometer and wipe from stem towards bulb.
11. Read at eye level and record temperature, replace
thermometer in container
12. Stretch patient’s arm and places sphygmomanometer
beside arm at the same level
13. Wound cuff around arm above elbow
14. Inflates cuff and palpates radial artery and notes level of
mercury at which pulse disappears
15. Wear and place stethoscope on brachial artery
16. Release pressure slowly and listen to sound with
stethoscope
17. Remove cuff and reassemble apparatus
18. Thank and make patient comfortable in bed
19. Wash and dry hands
20. Record blood pressure reading on vital signs chart and
nurses note

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1.9 TEPID SPONGING

1. Explain procedure to patient and provide privacy

2. Prepare trolley and send to bed side
3. Wash and dry hands
4. Take patient temperature, pulse and respiration
5. Arrange top bed clothes leaving top sheet
6. Protect bottom sheet and undress the patient
7. Wash and dry face to refresh patient
8. Leave a flannel rung out of cold water on the patient’s
forehead
9. Place 6 pieces of flannel into basin or tepid water
10. Place a wet flannel in each axilla and groin (wrung the
out tightly)
11. Change the wet flannel frequently to keep the tepid
12. Sponge upper arms, trunk, lower limbs and back in
strikes leaving some drops of water on the skin.
13. Change water as often as necessary
14. Leave patient for 15- 20 minutes
15. Dress patient up and recheck temperature and chart
16. Thank and make patient comfortable
17. Wash and dry hands and serve cold drink if necessary
18. Document procedure and report findings.

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1.10 ADMISSION OF PATIENT (AMBULANT)

1. Welcome patient and relatives to the nurses' station and

make them comfortable. Introduce yourself and any staff
present
2. Collect necessary documents, admission notes and any
other information from the accompanying nurse
3. Identify and confirm patient’s name, particulars and
reassure him.
4. Send patient to bed side and introduce him to other
patients near him
5. Check vital signs and record and collect specimen if
ordered
6. Administer urgent prescribed drugs if necessary
7. Assist patient to change into night dress or pyjamas
8. Take care of patient's valuable according to the
institutions policy
9. Let patient or legal guardians signs consent form for
treatment etc. where necessary
10. Explain national health insurance system to patient and
relatives
11. Inform relatives about visiting time and allows them to
see patient and say goodbye

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 12. Orientate patient to ward and its annexes
13. Use the nursing process to plan care
14. Enters patient's name into admission and discharge book
onto ward bed state and documents on nurses note

1.11 ORIENTATION OF PATIENT TO WARD

ENVIRONMENT (AMBULANT)

1. Establish rapport with patient by introducing yourself

2. Mention the name of ward to him
3. Show the patient the nurse's office. Show patient his bed
4. Show patient bathroom and toilet
5. Show patient dinning- hall and day room
6. Show patient the patient's cupboard and bed locker
7. Inform patient of ward activity
8. Tell patient whom to contact for any information
9. Encourage patient to ask questions
10. Thank patient and put him to bed

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1.12 COLLECTION OF SPECIMEN FROM A PATIENT
CONFINED TO BED

1. Explain procedure to patient and parent if child

2. Set trolley and send to patient's bedside with stool
specimen container and provide privacy
3. Wash hands and puts on gloves and serve bedpan or
urinal for patient to void
4. Serve a fresh and clean bedpan for patient to empty the
bowel and leaves patient till he has finished
5. Assist to clean up and remove bedpan and covers
immediately
6. Allow patient to wash and dry hands
7. Thank patient and make him comfortable
8. Use wooden spatula to take most representative stool
specimen from the bedpan, including mucus, blood, and
pus if any into the specimen container and cover it
9. Wrap the wooden spatula in paper towel and discard
10. Dispose stool, decontaminate bedpan and remove
disposable gloves and discard
11. Wash and dry hands
12. Document procedure and findings
13. Report any abnormality to nurse in charge

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 14. Label and send specimen to laboratory immediately with
well filled and signed request form

1.13 DISCHARGING A PATIENT FROM THE

HOSPITAL

1. Inform patient about discharge

2. Educate patient and relatives in the need for continuing
treatment and follow up care
3. Ensure the patient's hospital bills is worked out and
submitted to the patient's relatives early for settlement
4. Ensure that discharge papers are duly signed by
discharging doctor
5. Make sure that hospital bills are settle and all receipts
collected and handed over to patient
6. Direct relatives to collect drug for patient form the
pharmacy
7. Explain how the drug should be taken
8. Help patient to pack his belongings
9. Hand over any valuable in the nurses custody to the
patient and recorded witnessed and signed
10. Remind patient and relatives review date and stress on
its importance
11. Bid patient goodbye
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1.14 EDUCATING A PATIENT ON CONDITION

1. Make patient comfortable either by sitting or lying down

2. Sit comfortably by patient's side
3. Ensure enabling and relaxed environment
4. Find patient level of awareness of condition/diet
5. Build on what the patient knows with scientific data of
condition in a language the patient's understand
6. Explain to patient the rational for treatment and possible
outcome
7. Ensure patient understands teaching and co-operative
with health team
8. Allow patient to ask questions for clarification
9. Provide patient with simple pamphlets if available

1.15 TRANSFER OF PATIENT

1. Check that doctor has signed transfer document

2. Inform patient and relatives about the transfer and give
reasons
3. Inform the unit he is being transferred to about the
transfer and patient's condition
4. Ensure that all documents are completed

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 5. Help patient to pack belongings and ensure no ward
property or other patient's item is taken and makes a list
of patient's items
6. Ensure that receiving nurse checks patient's items
7. Record transfer in necessary document (file movement,
nurses' notes)
8. Accompany patient to the unit and introduce the nurses
to patient and the patient to the staff
9. Hand over patient's folder, medication and belongings to
receiving nurse
10. Ask the receiving nurse for only further questions
regarding to patient
11. Bid patient farewell
12. Ensure that bed linen, mattress and bedstead are
disinfected if patient has any infectious disease
13. Wash and dry hands

1.16 ASSISTED BATHROOM BATHING

1. Inform and explain procedure to patient importance of

bath and prepare bathroom
2. Prepares bathroom, collects the necessary articles and
arrange them for easy reach
3. Send patient to the bathroom
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 4. Ensure correct temperature of water
5. Provide privacy
6. Assist or encourages patient to undress
7. Provide for adaptive tools e.g. chair or stool in bath tub
when necessary
8. Assist patient to bath when necessary by washing the
back, feet as the case may be
9. Assist patient to dry up with towel
10. Assist patient to groom and change into new clothes if
necessary
11. Send patient to bedside and sit him comfortably in chair
as desired
12. Make patient bed and discard any dirty clothing and
makes patient comfortable
13. Collect toiletries, tidy bathroom and wash and dry hands
14. Document procedure and report findings

1.17 BED BATHING

1. Establish rapport and explain the procedure to the

patient
2. Prepare and take trolley to bedside and provide privacy
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3. Offer bedpan or urinal if required
4. Loosen and remove top bed clothes arrange on a
chair/bed table
5. Remove the patient's clothes and cover him with bath
towel /sheet/cloth being careful to maintain privacy and
to cause no pain or discomfort
6. Protect the bed and pillow with long mackintosh/plastic
sheet and draw sheet or cloth
7. Ask patient if he would like soap on his face, clean his
genitalia himself or not (the nurse uses her discretion but
respects the wishes of patient)
8. Ask patient for his preference and check temperature of
water
9. Wash, rinse and dry the patient's face beginning from
the inner to the outer canthus of each eye
10. Wash, rinse and dry the rest of the face, ears and neck,
take care to dry behind the ears and around the hair line
11. Wash, rinse and dry the arms, first the one farther away
from the nurse and then the arm nearest to the nurse. Pay
special attention to the hand, in between the fingers and
nails, cut the nails if necessary
12. Wash, rinse and dry the chest and abdomen, paying
attention to the skin folds, give special care of the area
24
 under the breast in women, to the umbilicus and the
folds of the skin in the groin
13. Wash, rinse and dry the legs the same way as the arms.
Place the feet singly in a bowl of water and cleanse
thoroughly if necessary. Attend to the toe nails and
pressure areas of the heels, ankles and knees.
14. Turn patient to the side and wash the back
15. Examine and treat the pressure areas
16. Change the bottom linen while patient is lying on his
side and roll patient on his back
17. Place the towel under the buttocks, roll the patient onto
his back, and offer a soapy-sponge for the patient to
wash the genital area if he is able. If not wash and dry
genitalia. Proper vulva toilet may be required in females
18. Groom and dress patient in clean clothes
19. Make the patient comfortable and thank him
20. Discard trolley, wash and dry hands
21. Document and report findings (abnormalities)

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1.18 TREATMENT OF PRESSURE AREAS

1. Explain procedure to patient

2. Prepare lukewarm water for the procedure
3. Set trolley and send to patient bedside and provide
privacy
4. Remove patient bedclothes and cover with sheet
5. Protect bed with mackintosh and draw towel
6. Roll patient onto the side, (left/right lateral) or prone,
with head turned to one side
7. Examine and note any abnormalities
8. Clean all pressure areas with soap and water in a soft
towel with gloved hands
9. Knead all pressure areas with finger pads, one area at a
time
10. Rinse and dry skin with a soft dry towel
11. Apply moisturizing cream or alcohol – free barrier
cream
12. Groom and make comfortable in bed
13. Position patient in any of the following positions at 30
degree angle, prone supine left/right, or left sim's
14. Thank patient and discard trolley

26
 15. Wash and dry hands and document procedure and
findings
16. Inform charge-nurse of any abnormalities

1.19 ADMINISTRATION OF TABLET

1. Check for the right patient, right drug, right time, and
right dose, ensure patient’s right to consent or to refuse
2. Establish rapport, explain procedure to patient and send
tray to the bedside
3. Identify patient by mentioning the name and checks
treatment sheet against doctor's order
4. Read the label on the container and compare with
patient's treatment sheet
5. Assess patient's condition and level of consciousness
and check vital signs where necessary e.g. digoxin
6. Remove lid of container, check label on container and
compare with patient, treatment sheet for the third time
7. Pour out water into a drinking glass or cup
8. Take the tablet with a spoon
9. Give the tablet to the patient in spoon and ensure that
patient swallows it
10. Congratulates patient and makes him comfortable in bed

27
 11. Discard tray, wash and dry hand and document
procedure

1.20 ADMINISTRATION OF MIXTURE

1. Identify and check for the right patient, right drug and
right time dose and route
2. Establish rapport, explain procedure to patient and tray
to bedside
3. Identify patient by mentioning the name and check with
treatment sheet
4. Read and compare the label on the bottle with patient’s
treatment sheet
5. Shake the bottle well
6. Remove the cork and holds it with the little or ring
finger, compare label on the bottle a second time with
patient’s treatment sheet
7. Pick the medicine glass and with the thumb nail mark
the level of the measure to be taken
8. Pour out the prescribe dose at eye level in bright light,
holding the bottle with the label upper most

28
 9. Replace the cork, read the label a third time, compare
with Patient’s treatment sheet and dose in the glass
10. Carry medicine to the patient on a tray or saucer, a
teaspoon may be added for stirring if it is a suspension
11. Supervise patient to drink the medicine and serve water
if necessary
12. Congratulate patient and make him comfortable in bed
13. Discard tray, wash and dry hands
14. Document procedure and sign treatment sheet

1.21 PREPARING TRAY AND GIVING

INTRAMUSCULAR INJECTION

1. Identify and check for the right patient, right route and
right time
2. Explain procedure to patient and provide privacy
3. Prepare and take tray to patient’s bedside
4. Check details again with patient’s treatment sheet
5. Wash and dry hands
6. Assemble syringe and needle using sterile technique
7. File and breaks ampoule or removes metal cap of vital
with a clean swab, and draw drug and discard needle

29
 8. Replace with a new needle and expel air
9. Assist patient into a required position and exposes site
for injection
10. Clean site with swab dipped in antiseptic lotion
11. Insert the needle quickly and firmly deep into the
muscle at the right angle
12. Push to release drug into the tissue
13. Withdraw the syringe and needle quickly and with swab
gently applies pressure to the point of injection
14. Discard syringe and needle into a container
15. Thank patient and leave him/her comfortable in bed
16. Wash and dry hands, sign treatment sheet and document

1.22 HANDING OVER THE WARD

1. Welcome the incoming staff

2. Allow incoming nurse to read the ward report on
patients
3. Explain issues and answer any questions that may be
raised
4. Move around from bed to bed to hand over patient

30
5. Maintain individuality of patient, hand over sensitive
information about patient at the nurse's office e.g.
condition of patient
6. Establish rapport with patient during handling over
7. Check and confirm information about patient chart
8. Check with incoming staff that gadgets on patients are
functioning e .g cardiac monitor, intravenous line,
oxygen apparatus and suction machine, abdominal tube
etc.
9. Check and hand over controlled drugs and any other
relevant resources available
10. Hand over ward annexes for incoming nurse to ensure
they are clean
11. Report on any defects on equipment and request made
for urgent repairs
12. Report on departmental instructions and other important
information e.g. clinical lectures and departmental
conferences
13. Hand over important issues in the ward diary

31
1.23 TAKING OVER A WARD

1. Greet staff on duty

2. Ask for oral information on major happening on the
ward from the outgoing nurse
3. Read written ward report
4. Take over ward from bed to bed verifying state of all
patient especially very ill ones
5. Establishes rapport with patients during taking over and
ask about state of health
6. Receive sensitive information about patient at the
nurses’ office
7. Conduct inspection of ward with an outstanding staff
8. Ensure resource needed for work available and adequate
and take over controlled drugs
9. Counter- sign written ward report
10. Note important issues in the ward diary
11. Congratulate outgoing staff

1.24 EDUCATING A PATIENT ON MEDICATION

PRIOR TO DISCHARGE

1. Establish rapport with patient

32
2. Use language client understands
3. Involve client's family or a significant other
4. Speak audibly to patient
5. Explain procedure to client and family
6. Assess patient's previous knowledge
7. Show type of drugs to patient
8. Inform patient about method of administration
9. Instruct patient on quantity of drugs to take at a time
10. Explain action of drugs
11. Describe the side effect of the drug
12. Instruct client to report to hospital when serious side
effect occur
13. Demonstrate to patient how to store drugs at home
safely
14. Explain patient important of follow- up
15. Explain patient laboratory follow-up when prescribed
16. Allow patient to ask questions
17. Respond to questions in a truthful manner
18. Thank patient for co-operation

33
1.25 EDUCATING A PATIENT ON MEDICATION AT
HOME AFTER DISCHARGE

1. Establish rapport and explain procedure to patient

2. Assess patient's previous knowledge
3. Show type of drugs to patient
4. Mention the name of drugs to patient
5. Instruct patient on quality of drugs to take
6. Describe the side effect of the drug
7. Instruct patient to report to hospital when serious side
effect occur
8. Demonstrate to patient how to store drug at home safely
9. Respond to questions in a knowledgeable manner
10. Allow patient to demonstrate knowledge gained
11. Uses language patient understands
12. Speak audibly to patient
13. Congratulate patient for co- operating

1.26 MOUTH CARE

1. Establish rapport and explain procedure to patient

2. Arrange requirement for patient and provide privacy
3. Assist patient into a suitable and a comfortable position
34
 4. Place towel over mackintosh cape under chin for
protection
5. Give brush with paste/ chewing sponge/ stick to patient
6. Encourage patient to brush the teeth or the nurse brush
patient’s teeth
7. Ensure that patient cleans the mouth thoroughly but
gently inside the cheeks, both sides of gum, teeth,
tongue and palate
8. Give water or mouth wash and void content into a
receiver
9. Make patient comfortable in bed
10. Wash and dry hands, record procedure and report any
finding

1.27 MOUTH CARE FOR SERIOUSLY

ILL/UNCONSCIOUS PATIENT

1. Explain procedure to patient and provide privacy

2. Prepare a tray and takes it to the patient’s bedside
3. Put patient in a suitable position
4. Protect patient's grown and bed linen with mackintosh
and towel
5. Pour lotion into gallipot, wash and dry hand

35
 6. Clean lips and outer part of teeth, open mouth and with
padded spatula inspect mouth for any abnormalities and
remove denture if any
7. Take swab with forceps, dips into cleaning lotion and
squeeze out excess
8. Clean mouth thoroughly but gently i.e. from inside, the
cheeks, both sides of gum, tongue and palate changing
swab frequently
9. Control movement of the tongue with spatula
10. Use tooth pick to clean between teeth
11. Clean mouth with water or any mouth wash
12. Clean lips and apply vaseline
13. Make patient comfortable in bed and remove screen
14. Discard tray, decontaminate, wash and sterilize
15. Wash hands and document procedure and findings

1.28 DRESSING OF WOUND (WITH ASSISTANCE)

1. Explain procedure to patient and provide privacy

2. Puts on mask, prepare and take trolley to bedside
3. Ask assistant to;
o Put patient into desired position
36
 o Protect bed clothes and expose area
o Pour out lotion into gallipots
o And remove plaster or bandage
4. Wash and dry hands and wear sterile gloves or use
sterile forceps
5. Remove soiled dressing using dissecting forceps or
disposable gloves and discard
6. Clean wounds with swab soaked in normal saline using
sterile forceps or sterile gloves starting from the wound
outward using one swab at a time
7. Clean wound with series of swabs until clean
8. Apply sufficient sterile dressing and secure into position
9. Inform patient about state of wound, thank and make
him comfortable in bed
10. Discard trolley, decontaminate used items and removes
gloves
11. Wash and dry hands and remove screen
12. Document and report state of wound

1.29 REMOVAL OF STITCHES

1. Establish rapport and explain procedure to the patient

37
2. Wear mask, prepare and take trolley to bed side and
provide privacy
3. Asks assistant to;
o Put patient into a comfortable position, protect
bed cloth and expose area to be dressed only
o Pour out lotions into gallipot and remove plaster
or bandages
4. Wash and dry hands
5. Remove soiled dressing with dissecting forceps and
discard
6. Clean wound with series of swabs soaked in antiseptic
lotion, place sterile swab near the wound
7. Takes dissecting forceps and stitch removes scissors,
grasp end of the stitch with the dissecting forceps and
pull gently to expose an area between the knot and the
skin
8. Cut stitch between the knot and the knot and the skin,
pulls out suture gently and slowly
9. Inspect carefully to make sure suture are removed and
discarded on a piece of gauze, noting number of sutures
removed
10. Clean wound, apply dressing and secure into position
11. Thank and make patient comfortable in bed
38
 12. Discard trolley and decontaminate instruments
13. Remove gloves, wash and dry hands and remove screen
14. Document and report state of the wound

1.30 REMOVAL OF CLIPS

1. Explain procedure to the patient and ensure privacy

2. Wear mask, prepare dressing trolley and take to the
patient’s bed side
o put patient into dressing position, adjust bed
clothes to expose area to be dressed and protect
bed lining
o pour out lotion into gallipots.
o remove plaster or bandage.
3. Wash and dry hands and put on gloves
4. Remove soiled dressing with dissecting forceps and
discards
5. Swab wound with antiseptic lotion using another sterile
forceps and places sterile swab near the wound.
6. Take clip removing forceps and dissecting forceps,
steady the clip with the dissecting forceps and insert one
blade of the clip removing forceps on top of it.
7. Press the blade together and then free the clips removed
8. Clean wound, apply dressing and secure into position
39
 9. Thank and make patient comfortable in bed
10. Discard trolley and decontaminate instruments
11. Remove gloves, wash and dry hands
12. Document procedure and report findings

1.31 PROCESSING INSTRUMENTS AFTER USE

1. Immerse all used instruments in a plastic bucket of

freshly prepared parazone solution for at least 10
minutes
2. Put on utility gloves and remove instruments from
parazone solution after 30 minutes
3. Rinse the instruments in warm or cold water
4. Scrub instruments using a soft brush with liquid
detergent, paying attention to the crevices/serrated ends
under water in a bowl
5. Rinse instrument thoroughly with clean water to remove
all detergents
6. Boil for 20 minutes in a boiler covered with a well-
fitting lid

OR

40
 7. Dry by air or with a clean towel if to be sterilised in
CSSD.

1.32 SPOON FEEDING OF AN ADULT ILL PATIENT

1. Explain procedure to patient, wash hands and prepare

meal tray with food, spoon, and a jug of drinking water,
cup and napkins
2. Offer bed pan if required before feeding is started.
3. Put patient in a comfortable position, washes and dries
hands
4. Give patient a mouth wash
5. Bring food in a tray to patient's bedside and protect
patient’s clothing with the napkin
6. Place yourself in a comfortable position and ask patient
if praying is preferred
7. Take food by spoon in small bits into patient's mouth
8. Allow patient time to chew and swallow
9. Continue feeding until patient is satisfied
10. Give water intermittently as required by patient and after
feeding
11. Clean patient's lips and gives a mouth wash
41
 12. Remove napkin and make patient comfortable
13. Congratulate patient and discard tray
14. Wash hands and document in nurses' notes

1.33 FEEDING A HELPLESS PATIENT

1. Establish rapport and explain procedure to patient

2. Ensure clean environment and provide privacy
3. Put patient in a comfortable position if patient's
condition would allow it. Put him in sitting up position
and arrange pillows on the back rest to support him. If
bed table is available, place it across the bed and use it
as a dining table before the patient
4. Place prepared tray with patient's choice of meal on the
cardiac table or bed table or patient's locker
5. Wash patient's hands with soap and water and dry with a
clean towel
6. Wash hands before serving meal (the nurse)
7. Place mackintosh and napkin/serviette across the chest
to protect bed linin and patient's dress
8. Sit at the bed side of the patient if convenient to make
patient feel relaxed
9. Cut food into bite sizes (e.g. Yam ) and feed patient with
leveled spoonful a little at a time
42
10. Allow him enough time to chew and swallow
11. Observe the rate at which patient eats
12. Coordinate the opening of the mouth and the
introduction of the food into the mouth
13. Place the spoon or fork accurately into the mouth i.e. not
too far back to produce gagging
14. Serve water in between feeding and at the end of the
meal using a spoon or flexible straw
15. Serve water to rinse mouth
16. Wipe patient's lips and chin when necessary
17. Remove used napkins/serviette and clear tray
18. Congratulate patient for efforts made in eating
19. Encourage patient to comment on the food
served/procedure
20. Document in the nurses' notes/ fluid intake and output
chat
21. Make patient comfortable
22. Wash hands with soap and water and dry with clean
towel

43
1.34 RECORDING INTAKE AND OUTPUT

1. Explain the importance of keeping the fluid balance

chart to patient to gain his co-operation
2. Explain the role patient has to play to him
3. Get requirements e.g. measuring jug for intake and
output, fluid chart and pen
4. Record all measurements in milliliters
5. Record amount of infusion/transfusion and other fluid
intake in the intake column
6. Record any output such as urine, watery stool, vomitus
at output column
7. Record any output for 24 hours depending on hospital
policy
8. Find fluid balance by subtracting output from
9. Inform the nurse in-charge/doctor if amount of output is
greater than the amount taken in or when there is
abnormally low output

44
1.35 EXAMINING HEAD AND HAIR

1. Establish rapport, explain procedure to patient and

provide privacy
2. Sit patient up in bed or assume comfortable position
3. Protect patient's shoulders with a towel
4. Protect bed and pillows
5. Wash and dry hands, wear disposable gloves where
necessary
6. Remove hair accessories if female
7. Comb hair carefully to remove tangles\
8. Part hair into several parts examine the scalp
9. Start from top to head down to end of nape
10. Examine for lice, dandruff, rashes, ringworm etc.
11. Repeat process taking special care to examine behind
ears, nape of neck and along hair line
12. Comb and style hair to suit patient
13. Thank patient for her co-operation
14. Wash and dry hands and document procedure and
findings

45
1.36 WASHING OF PATIENT'S HAIR

1. Establish rapport, explain procedure and rational to

patient
2. Prepare and send trolley to appropriate place
3. Put patient in a suitable position
4. Cover mackintosh with a bath towel under the patient's
neck and around the shoulder
5. Comb, remove tangles from hair and plug ears with
cotton balls
6. Wet hair and apply soap/shampoo
7. Massage scalp systematically starting at the front to the
back of the head.
Rinse and repeat till clean
8. Wipe any moisture around eye, face and neck
9. Squeeze hair gentility and dry thoroughly
10. Apply pomade, comb and style hair to patient's liking
11. Thank patient, discard trolley wash and dry hands
12. Document procedure and type of soap/shampoo and
report findings

46
1.37 TREATING PEDICULOUS HAIR

1. Explain procedure to patient and reassure him and

provide privacy
2. Take patient to bathroom or any appropriate place for
the procedure
3. Take tray to the place for the procedure
4. Sit patient comfortably on a chair
5. Put on gown and cover the hair with a triangular
bandage and wear gloves
6. Apply protective material around the neck and chest
7. Part the hair into small sections
8. Apply treatment lotion to the hair at various partings
9. Spread lotion in hair using cotton swabs
10. Cover the patient's head with a triangular bandage
11. Leave hair covered according to the type of lotion used
12. Set trolley and wash hair to remove the lotion
completely at the appropriate time
13. Use a fine tooth comb to remove the nits that may have
remained on the hair
14. Comb and style hair according to patient\’s choice and
thank patient

47
 15. Discard tray, gown and triangular bandage and wash
hands
16. Document procedure in nurses' note and thank him

1.38 SERVING A BEDPAN TO A HELPLESS PATIENT

1. Provide privacy
2. Bring a covered bedpan to the bedside and explain the
procedure to the patient
3. Stand at the right side of the bed and assistant on the
other side
4. Lift patient with assistant onto bedpan
5. Lift patient again with assistant to remove the bedpan
after use.
Cover the bedpan immediately
6. Clean patient
7. Arrange bedclothes and leave patient comfortable in bed
8. Allow patient to wash hands with soap and water and
dry hands
9. Take bedpan to the sluice room and inspect content
before emptying it
10. Measure urine if any and when necessary and record
48
 11. Empty bedpan, decontaminate, wash and sterilize it
12. Wash and dry hands and remove screen
13. Document procedure and report any abnormalities

1.39 PREPARATION AND CARE OF PATIENT

DURING AND AFTER LUMBER PUNCTURE

1. Explain procedure to the patient and reassure him to

gain his co-operation
2. Ensure consent form has been signed
3. Provide privacy and instruct patient to void before the
procedure
4. Wash hands, dry and put on gloves
5. Open the equipment tray taking care not to contaminate
it
6. Provide adequate lighting at the puncture site
7. Assist patient into a required position i.e. lying or sitting
and support him
8. Continue to support, observe and reassure patient
throughout the procedure
9. Apply firm strapping when the needle is withdrawn

49
 10. Allow patient to lie flat on back and make him
comfortable
11. Observe patient for the next 24hours for the following:

a. Leakage from puncture site

b. Headache

c. Backache

d. Vital signs

12. Express appreciation to patient. Remove and dispose off

equipment as appropriate
13. Document procedure and ensure specimen is labelled
and sent to the laboratory

1.40 SKIN PREPARATION FOR SURGERY

1. Explain procedure to the patient and provide privacy

2. Send prepared tray to bedside and put patient into
desired position
3. Expose the area to be prepared only and protect the bed
clothes

50
 4. Wash wide area around the operation site with soap and
water
5. Shave the area gently, avoiding cuts
6. Wash the area again after shaving and dry
7. Wash and dry hands and put on gloves
8. Cleanse the area with antiseptic solution
9. Apply sterile dressing towel or paper towel and secure
into position
10. Thank patient remove and discard tray and remove
screen
11. Decontaminate the equipment, remove gloves, wash and
dry hands
12. Document procedure and report any abnormalities of the
skin

1.41 PRE-OPERATIVE PREPARATION OF PATIENT

FOR SURGERY

1. Prepare a trolley with the following items:

51
 Shaving materials, gauze, antiseptic lotion, plaster, bowl
of water, soap and sponge, operation towel, operation
gown and BP apparatus

2. Explain procedure to patient and reassure him

3. Send trolley to bedside and provide privacy
4. Put o gloves and place patient into desired position
5. Exposed the area to be prepared and protect the bed
clothes
6. Wash area with soap and water and shave gently
7. Wash area with again with soap and water
8. Dry and clean with antiseptic lotion
9. Cover area with operating towel and secure it in position
with adhesive strappings
10. Gown patient with clean O.P. gown
11. Cover hair with towel
12. Check vital signs and record T.P.R. and BP
13. Ask patient to empty bladder
14. Thank patient and wash hands
15. Discard trolley
16. Give prescribed medication when patient is ready for the
theatre

52
1.42 CARE OF HANDS AND FEET

1. Establish rapport and explain procedure to patient

2. Provide privacy and take tray or trolley to bedside
3. Position patient comfortably
4. Cover the working area with mackintosh and dressing
towel on bed
5. Put bowl of warm water on the dressing mackintosh and
towel and put on gloves
6. Wet finger in a bowl of warm water and cut finger nails
7. Put hands into the bowl of warm water and scrub nails
gently with nail brush
8. Wash hands thoroughly using soap and sponge, rinse
and dry
9. Wet and cut toe nails across
10. Put all nail clippings into a receiver
11. Put feet into the bowl of warm water, wash feet
thoroughly using soap and sponge (if feet are very dirty
use nail brush to scrub them)
12. Apply petroleum jelly to hands and feet
13. Remove mackintosh and towel, make patient
comfortable and thank him
53
 14. Discard tray, wash your hands and dry them, document
procedure

1.43 LAST OFFICES

1. Prepare trolley and provide privacy

2. Turn body to lateral position with a receiver to collect
oral secretion
3. Turn body to the supine position and apply gentle
pressure over the lower abdomen to empty the bladder
into a receiver
4. Ensure eyes are closed and clean the body
5. Clean nostrils, ear and mouth and replace dentures if any
and remove all tubes
6. Trim the nails, shave male patient's beard
7. Remove all jewellery including wedding rings and
beads, record and hand over to the next of kin or ward
in-charge
8. Redress wound if any, secure dressing with tape or loose
bandage
9. Pack orifices – nostrils, ears, rectum and vagina with
cotton wool using forceps to prevent leakage
54
 10. Put a label on the arm or body bearing the following:

a. Full name

b. Age

c. Sex

d. Ward

e. Diagnosis

f. Date and time of admission

g. Date and time of death

2.0 MIDWIFERY PROCEDURES

2.1 BATHING A NEW BORN BABY AND CORD
DRESSING
1. Establish rapport, explain procedure to client and
collect baby
2. Put baby in a safe place and assemble all items to be
used

55
3. Misses and test temperature of water with elbow or
bath thermometer
4. Put on plastic apron, washes and dries hands
5. Put baby on a flat surface and undresses him or her
6. Wrap baby with the towel/cot sheet and clean baby’s
eyes and face with sterile cotton wool swabs soaked in
warm water
7. Clean baby’s face with damp face towel
8. Support the nap of the baby’s neck and plug baby’s
ears with two fingers
9. Washes the hair with soapy sponge, rinses and dries
10. Washes the arms and trunk to the feet
11. Turns the back with one arm supporting the chest and
washes the back down to the feet
12. Immerses baby’s body in a bath of warm water and
rinses thoroughly
13. Places baby on a bath towel/clean cot sheet
14. Uses small towel to dry paying attention to skin folds
15. Powders or oils baby and dresses him up
16. Washes and dries hands and put on sterile gloves
17. Observes ligature, cord clamp for looseness and re-
clamps or re-ligate if necessary
18. Holds stem or cord with one swab soaked in spirit
19. Swabs skin 5 cm away and around base of the cord.

56
2.2 EXAMINING A NEW BORN BABY IN THE
LABOUR WARD
1. Washes and dries hands and positions baby on a flat
surface
2. Undresses the baby, does general observation and
covers with a clean sheet
3. Examine baby’s head, face and neck
4. Examine the chest, abdomen and cord
5. Examines the arms and hands
6. Examines the genitalia
7. Examines hips and lower extremities
8. Examines the back and test patency of rectum
9. Redresses and places baby back into cot or sends to the
mother
10. Washes and dries hands and records finding

2.3 ACTIVE MANAGEMENT OF THE 3RD STAGE OF

LABOUR
1. Palpate to ensure there is no second baby
2. Explain procedure to the client and changes soiled
linen if necessary
3. Fills for contractions and pushes uterus backwards
4. Releases the forceps and clamps cord closer to the
vulva
5. Holds the forceps horizontally and applies traction on
the cord
6. Receives placenta into both hands and coarse
membranes out
57
 7. Examine placenta and membranes
8. Examine the genital tract
9. Rubs up uterus to expel clot and to initiate contraction
10. Tidy’s up client, applies clean perineal pad and
congratulate her
11. Makes client comfortable or moves client into 4th stage
room
12. Observes infection prevention techniques
13. Records finding throughout procedure and report to the
in-charge

2.4 CONDUCTING ABDOMINAL EXAMINATION ON A

PREGNANT CLIENT
1. Establishes rapport, explains procedure to client and
ask her to empty bladder
2. Provides privacy and put client in a recumbent
position.
3. Washes, dries and warms hand
4. Stands on the right side of the client, exposes and
inspects abdomen.
5. Measures synphysio-fundal height and performs fundal
palpation.
6. Performs lateral palpation
7. Instruct client to bend her knees slightly and breathe
slowly through the mouth.
8. Performs pelvic palpation and assesses head descend.
9. Listen and count fetal heart beat.
10. Assist client out of bed to redress.

58
 11. Communicate findings and thank her.
12. Washes, dries, report and record findings.

2.5 CONDUCTING 2ND STAGE OF LABOUR

1. Set delivery trolley and infant resuscitation tray ready
in the delivery room
2. Informs client on her condition and transfers into
delivery bed.
3. Ensures the bladder of client is empty and ask assistant
to position client.
4. Scrubs and put on protective clothing and clean client
upper thighs and vulva if necessary.
5. Drapes client and confirms dilatation of cervical os.
6. Apply clean pad to anal region and instruct assistant to
check FH with each contraction.
7. Instruct client to bear down with each contraction and
to rest in between reassuring client.
8. Maintain flection as head advances.
9. Infiltrate perineum and makes episiotomy if necessary.
10. Instruct client to pant when head crowns and delivers
the rest of the head by extension.
11. Feel for presence of cord around baby’s neck.
12. Cleans baby’s eyes and sucks mouth and throat.
13. Reminds mother that baby will be delivered unto her
abdomen as she waits for restitution and external
rotation of the fetal head to take place.
14. Delivers anterior shoulder and posterior shoulder.

59
2.6 TAKING A PAST HISTORY OF A PREGNANT
CLIENT
1. Establish rapport and explain procedure to client.
2. Ensures client is confortable and provides privacy.
3. Ask about the number of previous pregnancies for
client and what happened in each case.
4. Ask for interval between pregnancies and any ill
health.
5. Enquires about number of tetanus injections received
in life time.
6. Ask about the mode, place of delivery and duration of
labour for each child
7. Enquires if delivery of placenta for each child was
normal and the amount of blood lost in each.
8. Ask about any ill health following delivery.
9. Enquires about the condition, sex and weight of each
baby at birth.
10. Ask about any ill health of baby and at what age.
11. Ask if babies were breastfed and how long.
12. Ask type of family planning method used.
13. Enquires about immunization of babies.
14. Ask about family’s support, thanks her and record
finding.

2.7 GENERAL EXAMINATION OF PREGNANT

CLIENT AT THE ANTENAL CLINIC
1. Establish rapport and ask the client to empty her
bladder.
60
 2. Provides privacy, washes and dries hands.
3. Assist client to undress and wear gown.
4. Help client to adopt dorsal position.
5. Examine scalp and face.
6. Examines back, upper limbs and axillae.
7. Examines breast and teaches client breast self-
examination.
8. Inspect abdomen and notes finding.
9. Measures synphysio-fundal height and performs fundal
palpation.
10. Performs lateral palpations.
11. Instruct client to bend her knees slightly and breathe
slowly through the mouth.
12. Performs pelvic palpation and assesses head descent.
13. Listen and count fetal heart rate for 1 minute.
14. Examines the vulva.
15. Instruct client to lie on the side and examine the back.
16. Examines the lower limb.
17. Communicate findings to client.
18. Helps her out of the bed and assist her to redress.
19. Observe infection prevention procedure.
20. Thank client, report and record findings.

2.8 GIVING HEALTH EDUCATION ON PERSONAL

AND ENVIRONMENTAL HYGIENE TO A PREGNANT
WOMAN
1. Observe the client general appearance as she enters.

61
 2. Establish rapport with the client, provide a comfortable
environment and ensure privacy.
3. Explain to the client the need to attend antenatal clinic
and procedures involved.
4. Educate the client on the care of the hair and mouth.
5. Counsels the client on the need to bath with adequate
water and soap at least once a day.
6. Counsels her on the importance of keeping her finger
and toe nails short and clean.
7. Teaches client how to care for her perineum.
8. Counsels her to wear a loose cotton cloth, underwear,
low and well-fitting foot wear.
9. Teaches her on the importance of good ventilation and
lightening.
10. Teaches her the importance of sleeping under treated
mosquito net.
11. Educate client/support person on the need for clean
environment.
12. Encourages the client to ask questions and gives
appropriate answers.
13. Emphasizes the need for the client to adhere to the
information given and thank her.
14. Record all information.

2.9 HELPING TO FIX AND BREASTFEED BABY

1. Establish rapport and explain procedure to client.
2. Ensure client washes her hands and put client in a
comfortable position.

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 3. Ensure baby is dry and comfortable.
4. Washes hands, dries them and sit by the client.
5. Allows baby’s head to rest in the crook of the client
elbow.
6. Allows baby’s buttocks to rest in client’s palm while
supporting the baby’s back.
7. Assist client to ensure baby’s shoulders and hip are in
alignment.
8. Helps client to position baby so that the abdomen
touches client’s abdomen.
9. Assist client to adjust baby’s position to enable baby’s
chin to touch the breast.
10. Teaches client to elicit rooting reflex.
11. Assist client to insert the nipple and areola of the breast
into baby’s well opened mouth.
12. Instruct client to admire and talk to the baby as the
baby suckles.
13. Educate client to allow baby to empty one breast
completely before offering another.
14. Allows baby to release the breast after feeding.
15. Educate client to wind the baby after feeding.
16. Record and report procedure.

2.10 GIVING HEALTH EDUCATION ON DANGER

SIGNS TO A PREGNANT CLIENT
1. Establish rapport with the client, provides a
comfortable environment and ensures privacy.

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 2. Explain to the client the need to attend antenatal clinic
and procedures involved.
3. Informs the client to visit antenatal clinic at least
four(4) times before labour begins.
4. Informs client about the various aspect of physical
examination, laboratory investigations, scan etc
5. Explain and state the danger signs using educational
materials.
6. Stresses the client/support person the need to report
any danger signs immediately.
7. Dispels rumours relating to pregnancy and labour and
correct them.
8. Encourages the client to ask questions and give
appropriate answers.
9. Emphasizes on the need for client to adhere to the
information given and thank her.
10. Record all information received.

2.11 TESTING THE URINE OF A PREGNANT

WOMAN FOR SUGAR/PROTEIN
1. Put on a mackintosh apron and gloves.
2. Note quantity, colour, sediments and smell urine for
odour.
3. Measures specific gravity of urine where possible and
reads instructions on reagent bottle.
4. Take a stripe from reagent bottle and dip it into the
urine.

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 5. Removes stripes immediately and taps the edge of the
stripe against side of urine container.
6. Finds PH of urine immediately.
7. Compares test area closely with the corresponding
colour chart on bottle.
8. Discard items used.
9. Cleans and dries hand and record findings.

2.12 GIVING HEALTH EDUCATION ON NUTRITION

TO A PREGNANT WOMAN
1. Establish rapport, provide a comfortable environment
and ensures privacy.
2. Explains to the client the need to attend antenatal
clinic and procedures involved.
3. Finds out about the client eating habits.
4. Finds out about the local foods available and food
taboos.
5. Informs the client about the importance on adequate
and nutritious diet.
6. Teaches client about the sources of protective food,
energy giving food and body building foods with
examples.
7. Explains the importance of roughage and fluids in the
diet.
8. Educate client on the avoidance of intake of non-
nutritious substances.
9. Encourages the client to ask questions and give
appropriate answer.

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 10. Emphasizes the need for client to adhere to the
information given.
11. Thanks the client and records all information.

2.13 EXAMINING THE BREAST OF A PREGNANT

CLIENT
1. Establishes rapport and makes the client comfortable.
2. Explains procedure to client and ensures privacy.
3. Assist client to undress and wear a gown.
4. Helps her into a dorsal position on couch.
5. Washes, dries and warms hands, exposes both breast
and inspect.
6. Covers on breast and exposes the other.
7. Ask client to put the hand of the part to be examined
under her head.
8. Supports heavy breast.
9. Palpate the breast systematically and teaches the client
breast self-examination.
10. Squeezes the nipple gently for fluid, examines and
cleans with swab.
11. Repeat the same process for the other breast.
12. Assist client to redress, washes and dries hands.
13. Communicates findings to client and thanks her.
14. Records and reports findings.

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2.14 GIVING HEALTH EDUCATION ON BIRTH
PREPAREDNESS AND COMPLICATION READINESS
PLAN TO A PREGNANT CLIENT
1. Establishes rapport with the client provides a
comfortable environment and ensures privacy.
2. Explains to the client the need to attend antenatal clinic
regularly.
3. Informs the client about the importance of physical
examination, laboratory investigation, scan etc.
4. Informs the client about her expected date of delivery.
5. Enquires from the client on the preparations she has
made towards delivery and fill the gap.
6. Assist client to decide on the facility/ place of birth.
7. Assist in deciding on the necessary support including a
companion to stay with her during labour and to care
for children at home.
8. Counsels client/support person to register with the
national health insurance scheme (NHIS).
9. Educate the client on the signs and symptoms and what
to expect during labour.
10. Counsels client on the need for a skilled provider
during delivery.
11. Counsels client/support persons on how to save money
towards delivery and emergency.
12. Tells client/support persons to arrange for
transportation in times of need.
13. Ensures that client identifies an appropriate blood
donor who will be available during an emergency.
14. Educate clients on danger signs of pregnancy.

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 15. Encourages the client to ask questions and gives
appropriate answers.
16. Emphasizes the need for the client to adhere to the
information given her.
17. Records all information.

2.15 GIVING HEALTH EDUCATION ON PREVENTION

OF MALARIA TO A PREGNANT CLIENT
1. Establishes rapport, provides a comfortable
environment and ensures privacy.
2. Explains to the client the need to attend antenatal clinic
and procedures involved.
3. Finds out about her environment and how she protects
herself from mosquito bite.
4. Informs the client about the importance of sleeping in
insecticide treated mosquito net (ITN).
5. Teaches the client about the importance of
environmental cleanliness.
6. Informs the client about intermittent preventive
treatment (IPT), when to begin dosage.
7. Finds out about allergies to sulphur drugs and clients
G6PD status.
8. Educates clients on the importance of taking all 3 doses
at 4 weekly intervals night before 36weeks.
9. Informs her about the benefits of malaria prevention
and the risk of malaria to her and the unborn baby.
10. Educate client on the signs and symptoms of malaria
and the need to report promptly.

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 11. Allows client to ask questions and respond
appropriately.
12. Thanks her and records all information.

2.16 VULVAL SWABBING OF PUERPERAL CLIENT

1. Establishes rapport, explain procedure to client and
provides privacy.
2. Wears mackintosh apron and sends trolley to bed side.
3. Places mackintosh under client and drapes her.
4. Assist client into dorsal position with knees flexed.
5. Washes and dries hands and put on gloves.
6. Removes or ask client to remove soiled perineal pad
examines lochia.
7. Use five (5) or more swabs soaked in the lotion to
clean vulva.
8. Dries vulva using dry swabs and places clean perineal
pad on vulva.
9. Turns client to one side, dries buttocks and removes
mackintosh.
10. Ask client to wash her hands and makes client
comfortable.
11. Observes infection prevention procedure.
12. Removes gloves and washes hands.
13. Thanks client and records and report findings.

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2.17 GIVING HAELTH EDUCATION ON EXERCISE,
REST AND SLEEP TO A PREGNANT CLIENT
1. Establish rapport, provides a comfortable environment
and ensures privacy.
2. Finds out about the daily activities of the client.
3. Educate her on the importance of exercise, rest and
sleep during pregnancy.
4. Informs her about some of the exercises that a pregnant
client can perform.
5. Educate her on the importance of kegel’s and deep
breathing exercises and how to perform them.
6. Educate her against strenuous exercises.
7. Informs her about the need for adequate rest and sleep
during the day and the night.
8. Encourages client to ask questions and give appropriate
answers.
9. Dispels any rumors concerning exercise, rest and sleep
during pregnancy.
10. Ask for feedback and reinforce salient information.
11. Thank client and records.

2.18 VULVAL TOILETTING OF A PUERPERAL

CLIENT
1. Establish rapport, explain procedure to client and
provide privacy.
2. Sends trolley to bed side, washes and dries hands.
3. Places mackintosh under client and drapes her.
4. Place bed pan under client.
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 5. Mixes the water for swabbing with lotion.
6. Washes and dries hands, wear sterile gloves.
7. Pours water over vulva and clean the vestibule.
8. Cleans the labia minora, majora and then pours water
over vulva.
9. Cleans clients, dries and removes bed pan.
10. Places a clean pad at the vulva and makes her
comfortable.
11. Observes infection prevention procedures.
12. Thanks client and record findings.

2.19 EXAMINING A NEW BORN BABY IN A LYING-IN

1. Establish rapport and explains procedure to client.
2. Picks baby and places in a safe place.
3. Washes, dries hand and put on gloves (if baby has not
be bathed since birth)
4. Places baby on a flat surface and undress.
5. Examine the head and the face.
6. Examine the neck, chest and abdomen.
7. Examines the hands and arms.
8. Check the cord for bleeding and apply another clamp
or ligature if necessary.
9. Examines the external genitalia and test patency of
rectum.
10. Examine the hips, legs and feet.
11. Examines the back of the baby.
12. Wraps baby and give to client.
13. Communicates findings and thanks client.

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 14. Removes gloves (if used), washes and dries hands.
15. Records and reports findings.

3.0 PSYCHIATRIC NURSING PROCEDURES

3.1 FACILITATING COUNSELING SESSION

1. Inform patient about the counseling session, time, venue

and goals
2. Arrange the place -lighting, ventilation etc.
3. Arrange chairs in a semicircle or horseshoe fashion
4. Welcome patient with a smile to the venue
5. Allow patient to sit first whiles observing his gestures,
mannerisms and posture
6. Initiate conversation with a brief introduction
7. Encourage patient to express problems, fears and
conflicts
8. Identify patient's thoughts and feelings as he express
them
9. Identify with patient his perceived difficulties and
possible contributing factors to the problem
10. Speak in calm, soft voice during discussion without
being judgmental
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 11. Allow patient to come out with coping strategies
12. Avoid advising patient
13. Support patient to implement the strategies if possible
14. Monitor patient's activities in implementing the
strategies and assess his progress
15. Document the counseling session and inform patient
date and time for next session

3.2 FACILITATING GROUP THERAPY SESSION

1. Prepare a group of patients in the group session

2. Inform them about the procedure
3. Ensure participants have taken their meals and are well
groomed
4. Receive and seat participants to the session
5. Identify recorder for the session
6. Ask participants to introduce themselves
7. Discuss with participants the goals for the session
8. Explain sanctions for violating group norms
9. Initiate and direct discussion
10. Observe and involve all participants in the discussion
11. Identify conflicts and help participants to resolve them
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 12. Review conflicts and help participants to resolve them
13. Find out from members the benefits of the day's session
14. Establish date, time and venue for the next session
15. Close the session, arrange for departure of participants
and thank them
16. Review recording of proceedings with recorder

3.3 ASSISTING THE HYPOACTIVE (DEPRESSED)

PATIENT TO CLEAN THE MOUTH

1. Explain procedure to patient stressing on the importance

of cleaning the mouth to him
2. Prepare a tray for the procedure and send to the place to
undertake the procedure
3. Arrange for assistance depending on patients's condition
4. Assist and encourage the client to the place where the
procedure will be undertaken
5. Offer the patient a chair and make him comfortable
6. Cover patient's chest with a protective material e.g.
towel
7. Give patient some water to rinse the mouth
8. Use receiver to collect returned mouth wash (if no sink)

74
 9. Give patient brush with paste or chewing stick or sponge
10. Encourage and supervise patient to clean the teeth,
tongue and inside the mouth
11. Give patient water to rinse the mouth
12. Use receiver to collect returned mouth wash (if no sink)
13. Give towel to patient and assist him to wipe the mouth
14. Give weak lime solution to rinse the mouth
15. Use Vaseline on the lips
16. Remove protective material around the chest

3.4 PREPARING PATIENT FOR OCCUPATIONAL

THERAPY

1. Ensure that treatment has been prescribed by the doctor

2. Explain the rational and the importance of the therapy to
the patient
3. Allow patient to ask questions about the treatment and
provide him with factual answers
4. Refer difficult questions to ward in-charge
5. Inform patient about the time he is expected at the O.T
Department
6. Ensure that patient has taken bath and is well groomed

75
 7. Serve patient with meal and medication
8. Accompany patient to the O.T department
9. Introduce patient to O.T nurse and O.T patients
10. Hand over patient to O.T nurse
11. Note the time patient left for O.T department and when
he returns to the ward in his file and nurses' note
12. Ask for patient's work performance and social
interaction when he returns to the ward

3.5 ORGANIZING GROUND PAROLE

1. Inform patient about the parole

2. Prepare patient psychologically and physically
3. Explain the significance of the parole to him
4. Inform patient the rules of parole
5. Allow patient to ask questions and express his feelings
6. Ensure the patient has taken his bath and is well
groomed
7. Ensure he has taken his meal
8. Serve patient with his medication before he leaves
9. Document time and patient's mood before leaving the
ward
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 10. Inform other staff about the parole
11. Document time, patient's mood and attitude after
returning to the ward
12. Ask client about his feelings and expectations
13. Report immediately any change of mood or signs of
relapse

3.6 ADMINISTERING TABLETS TO THE

OVERACTIVE (ELATED) PATIENT

1. Establish rapport and explain procedure to the patient

2. Identify and check for right patient, right drug, right
dose, right route, right time and expiry date
3. Set a tray with the prescribed tablets, a cup of water and
patient's medicine card
4. Take tray to where patient and check the prescription
again with the drugs
5. Serve tablet with sufficient water or drop tablet into
patient's mouth and encourage him to swallow it
6. Inspect patient\’s mouth thoroughly and make sure the
tablet has been swallowed
7. Thank him for his co-operation and discard tray

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 8. Wash and dry hands, documents and sign in the nurses'
note
9. Observe patient for the effects and side effects of the
drug and report

3.7 ASSESSING THE PSYCHIATRIC PATIENT

1. Welcome and establish rapport and explain procedure

and rational to client
2. Sit patient comfortably on a chair and explain the reason
for the interaction to patient
3. Use simple clear language the patient understands
4. Assess appearance and general attitude
5. Assess motor activity and thought process
6. Assess speech and emotional state
7. Assess perceptual process and intelligence and
sensorium
8. Thank patient for his co-operation
9. Document assessment findings

3.8 INTERVIEWING THE PSYCHIATRIC PATIENT

1. Establish rapport, explain procedure to patient and

provide privacy

78
2. Seat patient comfortably facing the interviewer in a
quiet environment
3. Introduce yourself simply to the patient
4. Explain purpose and duration of interview
5. Seek for consent of the patient to record the interview
and assure him of confidentiality
6. Sit down avoiding crossing of arms and legs
7. Maintain eye contact and observe body language, verbal
feedback appropriate use of silence of patient
8. Initiate the dialogue in a simple language the patient can
understand
9. Speak to patient in calm, clear and relaxed tone
10. Find his area of motivation and nurture them for his co-
operation
11. Focus on specifics by using open ended questions
12. Listen and observe nonverbal cues
13. Give patient enough time to express himself and avoid
interrupting
14. Restate patient's statement by rephrasing and
paraphrasing
15. Ask patient to clarify statements where necessary
16. Summarize with patient what has been discussed during
the interview
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 17. Record salient points
18. Thank patient and close the interview session
19. Instruct patient on what to do next
20. Write the summary of the interview in the nurses' note

3.9 TUBE FEEDING THE HYPOACTIVE

(DEPRESSED) PATIENT

1. Explain the procedure to the patient stressing the need to

maintain his nutritional status
2. Provide privacy and send prepared feeding tray to
patient's bedside
3. Put patient in the most comfortable position, together
with the assistant
4. Assign the assistant to study the patient's head
5. Wash, dry hands and check if the NG tube is in the
stomach
6. Remove spigot and fix the barrel of a 20cc syringe to the
NG tube
7. Run about 10-15mls of normal saline or water through
the tube

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 8. Check temperature of feed and pour it into syringe and
allow to run by gravity
9. Pour the feed gradually until the required amount is
administered
10. Observe patient throughout the procedure
11. Run water (10-15mls) through the NG tube after feeding
12. Remove the syringe, clean the tip of the tube and fix the
spigot and secure the NG tube on the patient's neck
13. Make patient comfortable and thank him
14. Discard tray and wash hands
15. Document procedure on the intake and output chart and
nurses' note indicating patient\’s reaction and any other
observations

3.10 ADMINISTERING MIXTURES TO THE

OVERACTIVE PATIENT

1. Establish rapport and explain procedure to patient

2. Identify and check for the right patient, right drug, right
dose, right route, right time and expiry date
3. Read and compare the label on the bottle with patient's
treatment sheet

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4. Shake the bottle well
5. Remove the cork and hold it with the little or ring
finger; compare label a second time with the patient's
treatment sheet
6. Pick the medicine glass and with the thumb nail mark
the level of the measure to be taken
7. Pour out the prescribed dose at eye level in bright light
holding the bottle with the label uppermost
8. Replace the cork, read the label a third time, compare
with patient\’s treatment sheet and dose in the glass
9. Call patient by name in low voice
10. Get patient seated at a convenient place or follow patient
with the drug on a saucer (stirring if necessary)
11. Ask patient to open the mouth and pour the mixture in
(still following him if necessary)
12. Continue coaxing the patient to take the drug if he
refuses to take it
13. Remain with patient until the medication is swallowed
14. Ask for assistance if all measures prove futile
15. Thank and congratulate the patient for his co-operation
16. Discard tray, wash and dry hands
17. Document the procedure in the treatment sheet and
nurses' note
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3.11 ADMINISTERING TABLET TO THE
HYPOACTIVE PATIENT

1. Establish rapport and explain procedure to patient

2. Identify and check for the right patient, right drug, right
dose, right route, right time and expiry date of the
medicine
3. Identify patient by mentioning the name and check with
treatment sheet
4. Check any special observation or requirement relating
the medication
5. Ask for patient's co-operation and check his
understanding
6. Open the container and pick tablet with a spoon
ensuring the right drug and dosage
7. Suggest to and assist patient to tilt head backward and
support the head with the help of an assistant
8. Coaxes patient to open the mouth using minimum force
if necessary
9. Pour some water into the mouth followed by the tablet

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 10. Encourage patient to swallow the tablet (if he fails crush
the tablet and mix with water and pour mixture at the
back of the throat followed by water)
11. Rub the front of the neck gently to stimulate the
swallowing reflex
12. Speak gently and calmly to the patient throughout the
procedure using words of encouragement
13. Ensure that the patient swallows the drug
14. Make patient comfortable and thank him for his co-
operation
15. Return patient to his next planned activity
16. Discard tray, wash and dry hands
17. Document the procedure
18. Observe patient for effects and side effects of the
medication

3.12 TAKING HISTORY OF PSYCHIATRIC PATIENT

1. Establish rapport and explain procedure and rational to

patient and relatives
2. Involve patient in the interview process
3. Observe patient's behaviour and reactions
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 Direct the interview highlighting the following:

4. Personal data, family and developmental history

5. Medical/Surgical history
6. Previous mental illness and Personality before onset of
the present illness
7. History of present illness
8. Assess patient's psychological process
9. Record the interview
10. Check vital signs and record
11. Close the interview by summarizing the salient points
12. Instruct patient on what to do next
13. Complete the patient's history form and sign
14. Thank patient and relatives and document procedure

3.13 RESTRAINING THE AGGRESSIVE PATIENT ON

THE WARD

1. Establish rapport, explain procedure to patient and

provide privacy

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2. Identify extra help needed and instruct each as to her
role
3. Prepare and assemble items to be used for the selected
restraint approach
4. Assign each nurse a particular limb to hold in the
restraint
5. Assign a nurse to prepare for the injection (if necessary)
6. Give a cue to the team to approach the patient
simultaneously
7. Lead team to approach patient from the front in a semi-
circle
8. Speak to the patient in a firm but calm tone giving him
specific and concise direction
9. Direct patient towards nearest wall of floor
10. Hold blanket between yourself and patient if patient is
holding dangerous object
11. Grasp patient simultaneously by the clothing at the waist
and above the great joints
12. Carry patient to the bed and hold him for the period
required to calm him or administer the prepared
injection
13. Assess any injury to patient, other patients or staff

86
 14. Ensure that all items used are returned or stored
accordingly
15. Wash and dry hands and thank staff and patient
16. Document in nurses' note and patient's folder,
assessment both before and after the restraint
17. Continue to observe patient at frequent intervals
depending on patient's condition

3.14 MANAGING PATIENTS WITH INAPPROPRIATE

PERCEPTION (HALLUCINATION AND ILLUSION)

1. Approach patient in a calm manner

2. Verify interpretation of what patient is experiencing
3. Observe for verbal and nonverbal cues for hallucination
4. Acknowledge patient's feelings and experiences
5. Attempt to identify precipitating factors
6. Interrupt the hallucination and engage the patient's
attention in another area
7. Asses content of command environment
8. Direct the focus from hallucination expression to discuss
reality-centered situation

87
 9. Set limits for discussing repetitive hallucination
expressions
10. Validate interpretation of what is being said
11. Teach voice dismissal when possible
12. Give medication and monitor effectiveness
13. Document and report findings

3.15 ESTABLISHING RAPPORT WITH THE

PSYCHIATRIC PATIENT (DEVELOPING
INTERPERSONAL RELATIONSHIP)

1. Welcome the patient and introduce yourself as brief as

possible
2. Explain to the patient what he could expect from you as
a nurse
3. Offer seat to patient and sit near him
4. Find out patient's name and use it when addressing him
5. Speak to patient using simple, clear language
6. Encourage patient to talk and express his feelings and
listen mostly
7. Help patient to think through his problem in a logical
manner using appropriate cues and questions

88
 8. Show consistency in approaching the patient
9. Demonstrate firmness in dealing with requests and
behaviour by patient
10. Explain to patient the support and assistance he could
expect from you
11. Maintain a related attitude when interacting with him to
show patient that you have time for him

3.16 FEEDING THE HYPOACTIVE (DEPRESSED)

PATIENT

1. Establish rapport and explain procedure to patient

2. Explain the importance of food to the patient and give
him water to rinse the mouth
3. Prepare patient's food tray with preferred food and send
it to bedside or appropriate place
4. Put patient in a comfortable position protect patient's
chest with a protective material
5. Wash hands and patient's hands if he is to use his hands
for eating
6. Sit by patient and encourage patient to eat and if this
fails, spoon feed patient

89
 7. Take food in small bits into patient's mouth
8. Encourage and allow him enough time to chew and
swallow food
9. Make sure patient has taken enough food i.e. ½ of the
meal served
10. Give him water on demand or after eating
11. Remove protective material
12. Provide him with water in a bowl with soap to wash
hands and dry them
13. Make patient comfortable and thank him
14. Clean the tray and wash hands
15. Document the procedure and report any findings
observed during feeding

3.17 ADMINISTERING MIXTURES TO HYPOACTIVE

PSYCHIATRIC PATIENT

1. Establish rapport and explain procedure and rational to

patient
2. Identify and check for the right patient, right drug, right
route, right dose, right time and expiry date

90
3. Identify patient by mentioning the name and check with
the treatment sheet
4. Read and compare the label on the bottle with patient's
sheet
5. Shake the bottle, remove the cork and compare label a
second time with the patient's treatment
6. Pick the medicine glass and with the thumb nail mark
the level of the measure to be taken
7. Pour out the prescribed dose at eye level in bright light
holding the bottle with the label uppermost
8. Replace the cork, read the label a third time, compare
with patient's treatment sheet and dose in the glass
9. Call patient by name in a low voice and get him seated
at a convenient place
10. Suggest and help patient to turn head backwards and
support the head with the help of an assistant
11. Coaxes the patient to open the mouth or gently pry the
mouth open
12. Pour the mixture into patient's mouth directing it to the
back of the tongue
13. Rub the throat gently to stimulate swallowing reflex
14. Urge patient to swallow the drug
15. Create a situation for the patient to talk
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 16. Praise patient and thank him for his co-operation
17. Direct patient to another planned activity
18. Discard tray, wash and dry hands
19. Document procedures

3.18 ASSISTING THE HYPOACTIVE TO BATH IN

THE BATHROOM

1. Establish rapport and explain procedure and rationale to

patient
2. Prepare the bath by arranging the items at hand
3. Assist patient to the bathroom and undress
4. Hand sponge and soap to patient
5. Encourage the patient to perform the action himself,
giving positive reinforcement
6. Assist the patient to wash the body where necessary
7. Observe the body for any abnormalities
8. Assist and encourage patient to dry the body after bath
9. Assist patient to groom himself
10. Thank patient for his co-operation
11. Return patient to next planned activity
12. Clean and return items used to their appropriate places

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 13. Wash and dry hands.\n\n14. Record findings and
procedure in nurses note

3.19 FEEDING THE OVERACTIVE PATIENT

1. Establish rapport and explain procedure and rational to

patient
2. Wash, dry hands and prepare patient's food by finding
out what he would like to eat and drink
3. Give food in a form that patient can eat on the run
4. Put food into plastic plate/finger like food
5. Leave food at vantage points with spoon where
necessary and suggest to patient to pick it OR
6. Follow patient with the food and ask him to open his
mouth to take the food or drink
7. Repeat step six until patient is satisfied
8. Congratulate patient and discard the tray and wash
hands
9. Record the amount of food taking

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3.20 CARING FOR THE PATIENT AFTER ELECTRO-
CONVULSIVE THERAPY (ECT) IN THE WARD

1. Turn patient's head to one side

2. Check if patient is breathing
3. Check patient's vital signs every 15 minutes until patient
is fully conscious
4. Take appropriate action as condition demands
5. Dress any injury and document
6. Stay with patient until he is fully conscious
7. Ensure that patient get enough rest
8. Report severe headache to the in-charge for necessary
attention
9. Help patient out of bed and rinse the mouth
10. Remind patient that side effects of E.C.T. are temporal
11. Assess the patient's orientation to time, place and person
12. Serve medication and breakfast and encourage him to
eat
13. Allow patient to continue with daily activities
14. Document observation and any treatment given in
patient's note

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3.21 PREPARING FOR SECLUSION AND CARE OF
PATIENT IN SECLUSION

1. Ensure that seclusion is prescribed and organize

seclusion room
2. Ensure that seclusion room has a secured lock
3. Prepare observation chart
4. Identify restraint team in readiness for restraining the
patient
5. Explain to patient rationale or purpose of restraint in a
calm and soothing tone
6. Lead team to restrain patient with extra clothing and
remove dangerous articles from him
7. Maintain patient's value and dignity as a person while
restraining
8. Take restrained patient into the seclusion room and lock
him up
9. Observe patient's behaviour in seclusion every 15-20
minutes and record on observation chart
10. Ensure that patient receives his meal and fluids while in
seclusion
11. Provide opportunity for patient to use toilet when
necessary

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 12. Maintain communication with patient during the period
of seclusion
13. Administer prescribed drugs at appropriate time
14. Appraise the effectiveness of the seclusion
15. Document the procedure
16. Find alternative means of calming patient if he is still
disturbed in the seclusion room

3.22 ASSISTING THE OVERACTIVE (ELATED)

PATIENT TO CLEAN MOUTH

1. Establish rapport and explain procedure to patient

2. Arrange for assistance depending on patient's condition
3. Set tray for the procedure
4. Wash and dry hands and wear gloves if necessary
5. Stand or sit patient on a chair or stool as patient desires
6. Sit or stand in front of the patient and place face towel
under the chin
7. Remove dentures if any and place in a mug and inspect
mouth
8. Give patient brush with paste of choice /chewing stick
/chewing sponge
9. Supervise or assist patient to clean teeth and the inner
cheeks thoroughly
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 10. Give patient water or weal lime juice to rinse the mouth
11. Clean dentures using soft brush, rinses and replaces
teeth and thank patient
12. Discard tray, wash and dry hands
13. Document the procedure

3.23 FACILITATING FAMILY THERAPY

1. Establish rapport and set up an appointment for an

interview with the family
2. Prepare the room to receive the family and arrange chair
in horseshoe or semi-circular fashion
3. Welcome family and let them be at ease
4. Explain procedure to patient and family and provide
privacy
5. Allow family members to sit before you take your seat
6. Observe the sitting position of the family members and
verbal and non-verbal cues
7. Ask staff and family members to introduce themselves
8. Identify recorder for the session
9. Encourage open communication among the family
10. Gather data regarding family history
11. Allow family to explore additional problems that have
been bearing on the present family concerns
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 12. Assess and synthesize all the information given
13. Assess the various roles each family member plays
14. Determine if the family roles are rigid or flexible
15. Suggest way to resolve conflicts if any
16. Formulate interventions for bringing out positive
changes to resolve the identified problems
17. Establish date, time and venue for the next therapy
session
18. Thank them, close the session and arrange for departure
of family
19. Meet ward staff and discuss findings about family
therapy
20. Allow staff to come out with suggestive interventions to
problems identified
21. Relay suggestive interventions to patient/ family

3.24 ORGANIZING PATIENT'S DISCHARGE

1. Establish rapport and explain procedure and rationale to

patient and relatives
2. Check physician's discharge orders
3. Allow patient and relatives to ask questions
4. Check whether relatives have arranged for transport

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 5. Offer assistance as patient dresses and packs all personal
belongings
6. Check inventory book for patient's property
7. Check patient's room again for any belongings
8. Educate patient and relatives on take home medication
9. Emphasize follow up care and drug compliance
10. Direct patient to Social Welfare Department with
relatives
11. Record the health status of patient on discharge
12. Educate patient and relatives on the impact of patient's
lifestyle on his health
13. Write down the location of the next appointment with
the doctor at out-patient department
14. See patient and relatives off and document discharge in
admission and discharge book and daily ward state

3.25 SHAVING OF AMPIT AND PUBIS

1. Establish rapport and explain procedure and rationale to

patient
2. Prepare tray with items patient prefers to use
3. Send patient to treatment area and provide privacy
4. Assist patient to assume a comfortable position and
protect the bed and the patient's clothes
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 5. Wash, dry hands and wear gloves
6. Arrange patient's clothing to expose part to be shaved
7. Lather armpit/pubic area using soap and cotton wool
8. Shave armpit/pubic area using soap and cotton wool
9. Support the skin below the area being shaved
10. Rinse the razor after each stroke
11. hange water after shaving each area
12. Rinse and dry the armpit/pubic area when finished
13. Apply the patient\’s choice lotion of talcum powder
14. Make patient comfortable and thank him
15. Discard used items, remove gloves, wash and dry hands
16. Document procedure in patient's note.

4.0 FAMILY PLANNING

4.1 GENERAL COUNSELLING FOR FAMILY
PLANNING

1. Establish rapport and provide privacy.

2. Uses the necessary visual aids to inform client about
family planning methods available.
3. Tell client about the action and effectiveness of all the
methods.
4. Tell the client the health benefits and potential risks.
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 5. Explain how to prevent contracting HIV/AIDS and STIs
when using the methods.
6. Ask about which methods interest the client.
7. Assesses client knowledge about these methods and
correct any misconception.
8. Answer questions that the client may have.
9. Ask about the clients reproductive goals.
10. Assist client to make an informed choice of an
appropriate method.
11. Conduct any additional assessment on client necessary
for the method chosen.
12. Help the client to choose a different method if choice is
unsuitable after the additional assessment.
13. Provides the method of choice if available or refer to the
centre where service is available.
14. Encourage client to return to the clinic for follow up or
any time she has a problem.
15. Thank client and record procedure.

4.2 COUNSELLING CLIENT TO MAKE AN INFORMED

CHOICE (FAMILY PLANNING)

1. Establish rapport, make her comfortable and provide

privacy.
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 2. Finds out reasons for client’s visit and assure her of
confidentiality.
3. Take client's personal history.
4. Take client's medical/surgical history.
5. Take client reproductive history.
6. Asks client what she knows about family planning and
correct misconceptions.
7. Tell client about methods available and help her choose
a method.
8. Encourage client to ask questions and provide answers.

4.3 COUNSELLING CLIENT ON A FAMILY PLANNING

FOLLOW-UP VISIT

1. Establish rapport and provides privacy.

2. Explore the general health status or any change in client
since the introduction of F/P method.
3. Find out if she is happy about the choice she has made.
4. Check weight and blood pressure.
5. Ask client about her chosen method.
6. Check medical complications/problem, if any manages
or refer.
7. Replenish supplies if necessary and stress on
instructions again.
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 8. Thank her and record information.
9. Inform her about the next visit and indicate date on her

4.4 COUNSELLING AND ADMINISTRATION OF

INJECTABLE CONTRACEPTIVE TO A CLIENT

1. Establish rapport, explain procedure and make client

comfortable.
2. Ask client about her reproductive goals.
3. Allow her to make an informed choice among the
available injectable.
4. Discusses dual protection with the client.
5. Review client’s contraceptive and medical history to
determine if she is eligible.
6. Describe how the injection will be given.
7. Gather the necessary items.
8. Check the expiring date of the injectable to be given.
9. Position client appropriately, wash and dry hands.
10. Prepare and give injection.
11. Dispose off used materials using infection prevention
precautions.
12. Wash, dry hands, review common side effects and tell
client what to do if any occurs.

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 13. Ask client if she has questions or concerns and answer
appropriately.
14. Encourage client to return at any time she has a problem
or question.
15. Give appointment for next injection and records
appropriately.

4.5 COUNSELLING CLIENT ON NATURAL FAMILY

PLANNING (NFP) METHODS

1. Establish rapport and provide privacy.

2. Ask client/couple about their reproductive goals.
3. Asks client/couple what they know about natural family
planning methods.
4. Tell client/couple about natural family planning
methods.
5. Discuss dual protection with client/couple.
6. Provide client/couple additional information about each
natural family planning method.
7. Gives client/couple detailed instructions about selected
natural family planning method.
8. Allow client/couple to repeat instruction.

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 9. Ask client/couple if they questions or concerns and
answer appropriately.
10. Discuss return visit and follow up with client/couple.
11. Encourages client/couple to return anytime there is a
problem.
12. Thank her/the couple and record all information.

4.6 COUNSELLING CLIENT ON VOLUNTARY

SURGICAL CONTRACEPTION (VSC)

1. Establish rapport and provide privacy.

2. Takes reproductive history of client.
3. Takes basic medical and surgical history of client.
4. Ask client/couple what they know about VSC.
5. Counsel client/couple about VSC.
6. Tell client/couple how the procedure is carried out.
7. Encourage client/couple to ask questions and dispel
rumours.
8. Explain to client/couple the need for laboratory
examination before procedure.
9. Tell client/couple the need to sign a consent form.

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 10. Provide client/couple with another method before
surgery.
11. Refer client/couple to nearest facility that offers VSC.
12. Thank client/couple and record information.

4.7 COUNSELLING CLIENT ON SPERMICIDE

1. Establish rapport, explain procedure and make client

comfortable.
2. Ask client about her reproductive goals.
3. Ask client what she know about spermicide and
provides counseling.
4. Discuss dual protection with client.
5. Demonstrate how to use spermicide on a model.
6. Allow client to return demonstration on the model.
7. Ask client if she has questions or concerns and answer
appropriately.
8. Provides spermicide to client and tell her to return to the
same or nearest facility for follow up care and more
supplies.
9. Thank her, wash, dry hands and document procedure.

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4.8 COUNSELLING CLIENT ON INTRAUTERINE
DEVICE (IUD) AND ITS INSERTION

1. Establish report, explain procedure and make client

comfortable.
2. Ask client her reproductive goals.
3. Asks client what she knows about intrauterine device.
4. Provides counseling on intrauterine device (IUD).
5. Allow client to ask questions and answer appropriately.
6. Prepare client for physical and pelvic examination.
7. Ask client to empty bladder and help her onto the couch.
8. Conduct physical examination.
9. Drip appropriately for pelvic examination.
10. Wash, dry hands and put on examination gloves.
11. Arrange instrument and supplies on a sterile tray.
12. Provide adequate light and inspect the external genitalia.
13. Perform bimanual examination.
14. Insert vaginal speculum and perform speculum
examination.
15. Provide an overview of insertion procedure and remind
client to report any pain.
16. Clean cervical os and vaginal wall with antiseptic lotion.
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17. Grasp the cervix gently with a sterile tenaculum and
apply gentle traction.
18. Insert a sterile uterine sound using the ‘non-touch’
technique and note the uterine size.
19. Remove gloves and discard according to infection
prevention guide line.
20. Load the IUD in its sterile package.
21. Wash, dry hands and put on examination gloves.
22. Insert and release the loaded IUD carefully into the
uterus.
23. Remove tenaculum, examines cervix for bleeding and
arrest if any.
24. Remove speculum and discard according to infection
prevention guidelines.
25. Tack in UID string into the posterior vaginal fornix and
assist client out the couch.
26. Discard all instruments used according to infection
prevention guidelines
27. Wash, dry hands and document insertion of UID.
28. Thank client, provide post insertion counseling and
inform her of review visit date.
29. Observe client for at least 15 minutes before discharge.

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4.9 REMOVAL OF INTRAUTERINE DEVICE (IUD)

1. Establish report, explain procedure and make client

comfortable.
2. Ask woman her reason for IUD removal.
3. Provide an overview of removal procedure and remind
client to report any pain.
4. Determine whether woman will have another IUD
inserted, start a different method or neither.
5. Review client’s reproductive goals, need for STI
protection and counsel appropriately.
6. Arrange instruments and supplies for removal on a
sterile tray.
7. Tell client to empty her bladder.
8. Assist client to undress and position her unto the
examination table.
9. Wash hands thoroughly, dry and put on examination
gloves.
10. Swab vulva and insert sterile speculum gently to
visualize the strings and conditions of the vaginal wall.
11. Cleanse the cervical os and vaginal wall with antiseptic.
12. Apply steady but gentle traction and pulls towards her to
remove the UID.

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 13. Show UID to client and discard according to infection
prevention guidelines.
14. Assist client out of the couch and redress her.
15. Discard all used instrument according to infection
prevention guidelines.
16. Remove gloves, wash and dry hands.
17. Thank client and document IUD removal in client’s
card.
18. Observe client for at least 15 minutes before discharge.

5.0 CLINICAL ABBREVIATIONS

A&E……………………Accident and emergency

ABG……………………arterial blood gas

AC………………………before meals (ante cibum)

B/P………………………blood pressure

Bd/BD……………………twice daily

bid………………………..twice a day

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BUN………………………blood urine nitrogen

C/O…………………………complaint of

CBC……………………….complete blood count

CSF……………………….cerebrospinal fluid

CT……………………..computed topography

CXR…………………….chest X-ray

D & C…………………..dilatation and curettage

DOA…………………..dead on arrival

DOB…………………….date of birth

DPC…………………….delayed primary closure

DPM…………………………..drop per minute

FBC…………………………..full blood count

FBS…………………………..fasting blood sugar

FHR……………………….fetal heart rate

FFP………………………….fresh frozen plasma

Hb/hgb…………………………haemoglobin

LFT…………………………liver function test

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LOC………………………..loss of consciousness

Mane………………………morning

Nocte……………………… at night

NPO……………………… nothing by mouth

O/A……………………….on admission

qid……....quarter in die{derived from latin} (four times daily)

Rx…………………treatment/orders/prescription

Stat………………immediately (once only)

tds/tid……………………three times daily

CONCLUSION

Students ought to maximize the period of their training as

health personnel to develop and widen their scope of
knowledge & skills and to cultivate the right attitude that will
promote academic excellence and make them stand tall as
professionals in their various fields of endeavours.

But this can only be achieved through proper guidance (the

very essence of this book) coupled with discipline & hard
work.

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Written and compiled by Agyei et al.

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Contact: +233543179144, +233244870822, +233209962835
& +233248038418.

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