For Private Circulation only. Volume 5 Issue 3 December Supported by the Global Fund for AIDS, Tuberculosis and Malaria (GFATM)

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1 For Private Circulation only Volume 5 Issue 3 December 2013 Supported by the Global Fund for AIDS, Tuberculosis and Malaria (GFATM)

2 Editorial Board: Mr. T. Dileep Kumar Dr. Asha Sharma Mrs. K.S. Bharati Dr. Shirley David Mrs. Santosh Mehta Mrs. Meena Sonavane Mrs. Bulbul Kundu Ms. Catherine Myrthong Dr. S.N. Misra Dr. Dilip Vaswani Content and Design: Shanta Misra Cover: National Consensus Meet on Implementation of GFATM7 Project Hyderabad 14th & 15th December Please submit your contributions/ articles to INC Newsletter at: Published by the Indian Nursing Council, Combined Councils Building, Kotla Road, Temple Lane, New Delhi Contents The President s Desk 3 GFATM Nurses Training Project Successful completion of 4 5 years In Conversation 7 PLHIV Satisfaction Survey Midline Assessment Report Institutional Strengthening of Nurse Training on HIV/AIDS GFATM 7 Effectiveness of Planned Teaching Programme on 12 Knowledge Regarding Bio-medical Waste Management among Student Nurses Glimpses of GFATM Nurses Training 14 INC Announcements 16 The views expressed in the INC Newsletter are not necessarily those of the Indian Nursing Council or the editorial board and they accept no responsibility for them. GFATM Round 7 Training Update (September 2013) Activity Achievement Number of Nursing Institutes refurbished as Nurse Training Centers 51 Number of Master Trainers/Trainers trained on HIV/AIDS 848 Number of staff Nurses trained & retrained on HIV/AIDS 91,833 Number of ANM trained on HIV/AIDS 7079 Number of Nursing superintendents oriented 4508 Number of trained staff nurses provided with Supportive supervision

3 The President s Desk Welcome to next edition of our quarterly newsletter. The GFATM 7 project successfully completed its Phase 2 in August Beginning in 2008, this project completed the training of over 90,000 staff nurses and 848 faculties of nursing school and colleges as trainers on HIV/AIDS prevention care and treatment. The midline assessment of the project showed the PLHIV satisfaction on HIV services provided by these trained staff nurses to have increased from 58% in 2010 to 69% in Nurses are more confident in providing all services to PLHIVs without stigma and discrimination. In view of this achievement, the project has been awarded an extension till In this extension phase, the training of staff nurses and ANM on Tuberculosis care and treatment has been included, besides continuing with the HIV/AIDS trainings. An update on the GFATM training program provides more details. In our In Conversation section, we have Mrs Madonna Britto, Professor and Chief of Nursing Services, St. John s College of Nursing sharing her views and varied experiences. A study on the effectiveness of Planned teaching program regarding Biomedical waste makes very interesting reading. We look forward to your valuable feedback and suggestions. Sincerely, Mr. T Dileep Kumar President, Indian Nursing Council 3

4 GFATM Nurses Training Project Successful Completion of 5 Years Mrs. K. S. Bharati Joint Secretary, INC & Project Manager, GFATM Background The first of its kind Global Fund for AIDS, Malaria and Tuberculosis (GFATM) funded project, aimed at Strengthening Institutional Capacity of 55 Nursing Training institutes and training of 90,000 nurses and additional 5000 ANMs/GNMs, posted at 24x7 PHCs/ CCCs, on HIV/AIDS in India, was successfully executed for period from 2008 to 2013 by Indian Nursing Council(INC), in coordination with the National AIDS Control Organization (NACO) with the support of the management agency, Futures Group International Pvt. Ltd. a Sub-Recipient (SR). The Cumulative signed amount under the project is $ 38 million. INC is the Principal Recipient (PR) under this project. Five of the identified nursing training institutes are designated as Sub Recipients (SRs). These SRs have been developed as Regional Resource Centres(RCCs) for nursing training and are responsible for overall training/capacity building of 40 nursing training institutes designated as Sub-sub Recipients (SSRs). In addition, Catholic Bishop Conference of India (CBCI) is another SR responsible for logistics, administrative, financial specifics of 10 additional SSRs. The training module, based on the consensus among various stakeholders NACO, INC, State Nursing Councils (SNRC) and experts from the field of HIV/AIDS to incorporate core competence and best practices, was tailored according to the needs of nurses. The training includes the following: 1. Training of Nursing Faculty as Trainers 6 day module on HIV/AIDS and ART: a. Faculty from all INC certified and approved Government nursing colleges/schools and certified and approved private colleges/ schools. 2. Training of ANM Faculty as Trainers 3 day module on HIV/AIDS: a. Faculty from INC certified ANM schools 3. Training of Staff nurses 6 day module on HIV/ AIDS and ART: a. Staff nurses from tertiary, district hospitals and CHC/PHCs from all disciplines including NACO contracted ART nurses b. Includes all government hospitals and charitable hospitals and select large private sector hospitals from across all districts 4. Training of ANM 3 day module on HIV/AIDS: a. FICTC ANM and other ANM posted in District hospitals and PHCs. 5. Orientation of Nursing superintendents one day program 6. Supportive Supervision to trained nurses: a. The trainers visit the trained nurses in their place of work ( ie tertiary and district hospitals) to supervise the onsite working of the nurses and provide additional hands-on support if required. 7. E-learning a self-learning program on the 6 day training package for the nurses is available online at the INC website and accessible to all certified nurses. India is the first and so far the only country, to receive funds, for training of nurses in care, support and management of People Living with HIV/AIDS (PLHIV) in the world by GFATM. The project specifically, geared for the in service staff nurses, who are involved in direct patient care, in the OPDs, Surgical wards, Operation Theatres & Labour rooms, PPTCT clinics, ART Centres etc., has not only enhanced the knowledge of nurses on HIV prevention, care and antiretroviral therapy for adults, pregnant women and children, but also has equipped them with counselling skills, which has enabled them to care for People Living with HIV/AIDS (PLHIV) in a comprehensive and confident manner. As a result, they, 4

5 slowly, are, carving out a key role for themselves in the multidisciplinary team taking care of PLHIV. Considering the success of the GFATM training for the staff nurses, NACO entrusted Indian Nursing Council with the additional responsibility to train the ANMs also because as important grass root level workers, it is imperative to train them for carrying out and supervision of ongoing NACP-III activities related to effective prevention, detection, referrals and treatment strategies of HIV infection. During phase II of the project, FICTC based ANMs were trained on the basis of NACO approved 3 day training curriculum, specifically, designed to suit their educational level and work scope through few select training institutes (nominated under the GFATM project). The main topics included for the 3 day module are as follows: m Basic Information on HIV/AIDS, including disease progression, diagnosis and ART m Stigma & Discrimination m Counselling in HIV/AIDS care m Prevention of HIV transmission m Prevention of Parent to Child Transmission (PPTCT)and Early Infant Diagnosis(EID) m Infection Control m Documentation and reporting m Sexually Transmitted Infections (STIs) The project also aimed at establishing Training Management Information System (TMIS). This system linked INC/SR/SSR in relation to data collection, analysis and dissemination. Targets and achievements of the project: August 2013 Since its inception in 2008, the project has consistently realized its targets and has displayed excellent accomplishment of various Performance Indicators. Some of the key achievements of the project are: S. Performance Indicators Targets Achieve- No. ments (%) 1. Number of Training Institutes Refurbish & Functional (94.5%) 2. Master Trainers & Trainers Trained (108.7%) 3. Number of In-Service Nurses Trained (94.55%) 4. Number of Trained Nurses Provided With Supportive (98%) Supervision 5. Number of Nursing Superintendents invited (85%) for annual meeting for implementation of nursing training 6. Number of ANMs/GNMs working in the 24x7 (149%) PHCs/CCCs trained 7. % of HIV+ Patients Who 69% Access ART Services Who Report Satisfaction With The Nursing Services Average Pretest and Post test scores from TOT/TONs Percentage Government Private/Charitable Percentage Pretest Post test Phase 1 Phase 2 Cummulative Phase 1 Phase 2 Strengthening institutional capacity for nursing training on HIV/AIDS (GFATM R7) Strengthening institutional capacity for nursing training on HIV/AIDS (GFATM R7) 1. Midline Assessment 5

6 Supporting Supervision Scores Zone Knowlege Clinical Inter- Infection Non Base Skills personal Control Discrimi- Skills Practices natory Practices North 68% 68% 68% 68% 72% (Average) (Average) (Average) (Average) (Strong) West 70% 75% 75% 76% 80% (Average) (Strong) (Strong) (Strong) (Strong) South 68% 72% 72% 72% 75% (Average) (Strong) (Strong) (Strong) (Strong) East 60% 68% 62% 65% 66% (Average) (Average) (Average) (Average) (Average) North 63% 68% 66% 66% 72% East (Average) (Average) (Average) (Average) (Strong) Some of the other significant achievements are: m Establishment of 5 Regional Resources Centres to co-ordinate and implement the project at regional level and for mentoring and cross learning, equipped with resource packs. They are in charge of mentoring support, Cross learning and are responsible for overall training/capacity building of about 4 to 10 nursing training institutes in their region, working with them as implementers (designated as Sub-Sub Receipts-SSRs). They are: Ø College of Nursing, CMC Vellore South Zone Percentage Grading of Trainers - Performance rating >65% East North North-East Strengthening institutional capacity for nursing training on HIV/AIDS (GFATM R7) Ø Institute of Nursing Education, Mumbai- West Zone Ø Raj Kumari Amrit Kaur College of Nursing, New Delhi- North Zone Ø West Bengal Govt. College of Nursing, SSKM Hospital, Kolkata- East Zone Ø NEIGRIMS, Shillong- North East Zone In addition Catholic Bishop Conference of India (CBCI) is another SR, whose role is limited to logistic, financial and administrative support for 10 institutions under its control. West South Commulative 6

7 m Establishment of TMIS, which is intrinsic to M&E to generate efficient & reliable training data collection, aggregation, analysis solutions and vital reports related to training/capacity building of nurses under the Round 7 GFATM project, using state of art technologies to support the M&E requirements of the project. m Development of E learning module on the GFATM TMIS, for a wider access, to various categories of the Health professionals. This online program is complementary to the ongoing 6-day classroom training courses conducted by the 55 nursing institutes all over India and includes all the fifteen units of the 6 day training program for nurses on HIV/AIDS & ART. It consists of the textual content, in the form of power point slides, along with audio visual components to improve the learning process. The online program can be accessed through the Indian Nursing Council website: testcharts/home.aspx The average Pre training score was 56.5% and the average Post training score was found to be 78%. m Most trainers were appreciated by the participants for their knowledge, technique and skills, and have received quite high ratings ( an average of 4/5) m The initial skepticism regarding the relevance/ benefits of this training, have slowly been replaced with appreciation and admiration. As a result, the Health facilities have readily started releasing / proposing the names of nurses, for the future training programs m Development of interpersonal communication & leadership skills, critical thinking, time management, team work etc. MIS Home Page In Conversation Mumbai. Mrs. Madonna Britto Professor & Chief of Nursing Services St. Johns College of Nursing Mrs. Madonna Britto is the Principal Coordinator of the GFATM Project in St. John s College of Nursing. Prof. Madonna Britto holds the post of Chief of Nursing Services at St. John s Medical Hospital, SJNAHS. She is the Reporting Point of Contact for Principal College of Nursing and Nursing Superintendent of St. John s Medical College Hospital. With over 27 years of experience in the field of nursing, Mrs. Britto completed B.Sc. Nursing in 1983 and M.Sc. Nursing in 1987 from L.T. College of Nursing, SNDT University, She has been Principal of St. John s College of Nursing from She has been Professor and Head of Medical Surgical Nursing Department, St. John s College of Nursing and under her able supervision as Research guide for Master thesis, 40 master thesis have been approved by Rajiv Gandhi University of Health Sciences (RGUHS), Bangalore. She has held the post of dean of faculty of Nursing at Rajiv Gandhi University of Health Sciences. Mrs. Britto has also held the post of Ad hoc Committee member in CMC Vellore for College of Nursing Dean Selection and Cadre and Recruitment Committee of CMC Vellore. Mrs. Britto shared her views in conversation with Shanta Misra Q. As the Chief of Nursing, who is managing both education and service, how do you manage to juggle between academic and administrative responsibilities and usually which role takes time & effort? 7

8 A. It is a myth that managing both responsibilities is impossible, In fact an integrated head of nursing is the best person to uplift both education & services alike. Handling the college & Hospital as two watertight compartments is not my strategy. I believe in empowering both the nursing teams to work in unison. My present role helps keep me more slim, trim & fit physically, academically & professionally with the right attitude and skill. In my opinion, any specialization / advanced education loses its value if not translated into service to the consumer - in this case the patients. Hence I would say my role is not really a juggle, it is smooth and effortless & I enjoy it. Q. Madam, what is your core area of interest? Please tell us more about it. A. My core area of interest is uplifting my profession, but that doesn t mean I am a workaholic, I enjoy dance & dramatics and grab the stage when opportunity presents. I believe in having a free spirit laugh openly, & transmit vibrancy irrespective of the level of the group, be it students, staff nurses, superiors or interdisciplinary group. Q. How has the nursing curriculum changed since the last decade? A. The nursing curriculum in the last decade has made more changes than ever before. Specialization has done well by uplifting theoretical core of nurses, but it has increased the tendency of the student to move away from bedside. Lack of clinical facilities available to students due to mushrooming of colleges with no attached hospitals, has worsened the problem. This evokes a fear in me regarding the risk to the society it s time we wake up. Q. St. John s College of Nursing is among the foremost institutions in India, what are the unique standards of excellence they have adopted? A. Our first step is quality recruitment be it students or staff. Once they are in the St. John s family, they are groomed to fit into the values & ethos. It is tough for some who may decide to quit the system, but no problem this mighty institution still continues to grow & serve society. Another plus point of St. John s is the work environment, where no one loses the focus of the goal achieving quality. St. John s academy provides for all round development of each individual by encouraging them to grab every opportunity & instilling in them the fact that there is no substitute to hard work. Q. Ma am you have a keen interest in extracurricular activities please tell our readers about it how important it is to go hand in hand with academic pursuits? A. As I said earlier, I enjoy dance & dramatics because I believe it uplifts our spirit & creates a positive environment. I balance between professional demands & relaxation in my personal life and I don t mix them. For my subordinates, I don t believe in just being a hard task master, I want them also to enjoy both aspects of life professional & personal. I strongly believe that we as Nurses need to lead a balanced life & overcome all life style diseases. For this it is essential to concentrate on self care practices. In nursing profession we tend to care for others in need & forget to care for self. As usual we ask about your Favourite things : Favourite Person: My Father Favourite Hobby: Cooking & trying my own new recipes. Favourite movie: Sound of Music. Favourite holiday: 52 favourite holidays per year, MY SUNDAYS Favourite Quote: The one given by the founder of our profession. I attribute my success to this I never gave or took any excuse Florence Nightingale. One Message for all our Readers: Be proud to be a nurse & Balance you work life & Personal life. Thank you for sharing your views. 8

9 Introduction PLHIV Satisfaction Survey Midline Assessment Report Institutional Strengthening of Nurse Training on HIV/AIDS GFATM 7 India contributes to nearly 7 per cent of the global burden of 33 million HIV cases. NACP-III has yielded significant results in addressing previously existing gaps in the AIDS response through an integration of programs for care & support and treatment along with the preventive efforts. This entails a substantial increase of cutting edge human resources like nurses who provide care, support and counseling. The GFATM project aims at strengthening and capacity building of 55 nursing training institutes and training 90,000 nurses in India, on HIV/AIDS and ART within a period of 5 years ( ). Indian Nursing Council (INC) will implement it in coordination with the National AIDS Control Organization (NACO) with the support of the management agency, Futures Group International India Pvt. Ltd. and Catholic Bishops Conference of India (CBCI). As of March 2011, nearly 4.5 lakh People Living with HIV in India, including 26,238 children, are receiving free Anti Retroviral Treatment (ART) at around 500 ART centers and Link ART Centers in the country. The Universal Access to second line ART in a phased manner and launch of Infant and child diagnosis are some of the initiatives launched to combat AIDS. Government of India in its continued efforts in fight against HIV has launched the National AIDS Control Programme (NACP - IV). The 3 rd round of PLHIV satisfaction is part of the midline assessment conducted under the GFATM Nurses training project on PLHIV satisfaction with regard to the services received from the health care providers (nurses) at ART centers. It is a cross sectional survey held during March and April Twenty high prevalence districts from 5 zones were selected for the purpose of the study. Survey was offered to a random sample of 55 PLHIV from each district including 3-4 HIV positive antenatal women who were availing services at Summary Report the ART centers and the PPTCT centers. Interviews were conducted in vernacular language using a semi-structured questionnaire through INC. Verbal informed consent was taken from the respondents. The data hence collected was analyzed using SPSS version 17. Results 948 PLHIVs including 78 pregnant women were interviewed for the purpose of the assessment. Vastly the services provided at the ART centers were rated highly satisfactory by 69% of the respondents. Most availed service was medical examination and satisfaction of the PLHIVs was highest for ART. All transgender respondents and females responded more favourably as compared to males Almost all patients reported that they were greeted warmly and offered seat by nurses. Similarly, almost all patients reported that the treating nurse was polite, attentive, showed respect, and used non-technical words and were confident and knowledgeable. There has been slight improvement in comparison to the earlier assessment in percentage of respondents who feel their fears and concerns were adequately addressed (83.6%), felt encouraged to ask questions by nurse( 86.3%) and were given adequate time by nurse to clear doubts and concerns (90.7%). Fig. 1: Age of respondents 31% 2% 1% 3% 7% 19% 37% Age Below and above Not responded 9

10 Fig. 2: Marital status of respondents 2% 14% 9% 75% Marital Status Unmarried Married However 23% of clients felt discrimination or isolation at some point during their visits to the ART centers and 5% of them reported having been denied of services. All the aspects of Health Education were imparted to the PLHIV, however counseling on physical exercise was given to least number of respondents (77.2%). 27.5% of the respondents felt that phone calls and other patients disturbed them during their interaction with nurse. 94% responded positively when asked if they would return to the ART centre to avail the services. The association between gender and client satisfaction consistently remained statistically significant throughout the study. A total of 63% of the pregnant women interviewed were aware of HIV testing and its importance during pregnancy. The major source of information continues to be health worker. Most of the women were aware of PPTCT risks and 82% were advised to get newborn tested for HIV. Majority of the women were counseled Fig. 3: Services availed at the ART Centers Adherence Counseling Medical examination Lab investigation ART Divorced/Separated/ Widowed Not responded Reffered Any other services Fig. 4: Overall satisfaction levels of services availed at the ART centers Very Dissatisfied Satisfied Fig. 5: Availability of Education materials at the ART centers 9% 16% 8% All of the Time Rarely 69% 5% 1% 1% 3% Dissatisfied Highly Satisfied 4% 19% Most Times Never 39% 26% on infant feeding practices whoever 76% reported to have comprehended the information. Counseling on healthy diet and vitamin supplementation was provided to 91% of the women, safe sex (use of condoms) 78.2%, need to prevent OI/STIs and RTIs in 70.5% and adherence counseling to 60.3%. Nurse discussed family planning methods with most of the women (97%). 29% of the pregnant women faced discrimination at the ANC facility. Conclusions and recommendations Not Sure Sometimes Does Not Apply There has been substantial increase in the satisfaction level of the PLHIV compared to baseline report to present 69% of the respondents being highly satisfied but certain areas of concern: denial of services and discrimination remain to be tackled. Stigma reduction practices should be implemented aggressively. Awareness about HIV testing and PPTCT risks has increased among the women. However some 10

11 Fig. 6: Taking HIV test at ANC on the day offered Fig. 7: Denial of services experienced by PLHIV 21% 100% 79% Yes No 80% 60% 61% 91% No of them continue to face discrimination at the ANC facility, which should be reduced through appropriate interventions. HIV test should be offered to husband/ partner of HIV positive women seeking ANC facilities. Mixed feeding continues to be recommended by few nurses, which should be discouraged. Counseling at the PPTCT center must also stress on prevention of OIs/STIs/RTIs, safe sex during pregnancy and adherence to ART. All women should be advised for newborn testing for HIV infection. Generally, providing and managing HIV/AIDS care is a complex process, because people need life- 40% 20% 0% 39% long care, counseling and monitoring so they can take their drugs consistently and correctly and live positively to avoid further problems. Therefore, ART and PPTCT centers that are the focal point of this care need to ensure that it is of good quality and provides satisfactory services to PLHIVs. 5% Yes Full report at Effectiveness of Planned Teaching Programme on Knowledge Regarding Bio-medical Waste Management among Student Nurses Vatchala Devi 1 and Indra Kala Rai² Introduction The necessity of managing health care waste in a scientific manner has been receiving increasing attention in India over the past few years due to the serious threat to public health, pollution of air, water and land resources arising out of its improper management. As per the reports from developed countries approximately 1-5 kgs of waste is generated per bed per day, whereas 1-2 kgs/bed/day is the figure from developing countries. In India it is estimated to be 2.0 kgs/bed/day. Improper handling of solid waste in the hospital may increase the airborne pathogenic micro-organisms, which could adversely affect the hospital environment and the community as well. Bio-medical wastes, if not handled in a proper way, is a potent source of diseases like AIDS, Hepatitis B and C, tuberculosis and other bacterial diseases causing serious threats to human health. Nearly one-third of the world population is infected with tuberculosis, which kills 3 million people every year. Tuberculosis causes more deaths than any other infectious agent in the world. Global TB report says 900,000 cases in India either not diagnosed or not reported to health authorities. India leads the list of countries with high incidence of tuberculosis and accounted for 31% of the total cases in the world. In 2012, around 8.6 million people got infected with tuberculosis and 1.3 million people died of the disease 1 Assistant Professor and HOD of Pediatric Nursing Dept, Gayathri College of Nursing, Kottigepalya, Bangalore-91, E.mail:vathsala.ragavan@ gmail.com. Contact No: ²Hira Maya Gurung³, Clinical Instructors, Gayathri College of Nursing, Kottigepalya, Bangalore

12 (940,000 people who died were HIV negative and 320,000 were HIV positive). Incidence and prevalence of these infectious diseases are increasing due to inappropriate use, storage, treatment, transport and disposal of biomedical waste. Hospitals should take greater care in disposing biomedical wastes. Bio-safety is an essentially a preventive concept and consists of wide variety of safety precautions that are to be undertaken. A study was therefore, conducted to understand the awareness amongst the student nurses on biomedical waste management, so that policies for improved status is formulated in future. Materials and Methods An evaluative research approach was adopted for this study. Pre-experimental one group pretest and posttest design was used. 60 student nurses who fulfilled inclusion criteria were recruited for the study by purposive sampling technique. The study was conducted over a period of 3 months from June 2013 to August 2013 in Gayathri College of Nursing. The questionnaire was validated by 5 experts for appropriateness, organization of content and grammar, adequacy, relevance and comprehensiveness. Reliability of the tool was assessed by using split half method of Karl Pearson Correlation. The tool was found to be reliable(r=0.84) for main study. The questionnaire was distributed to student nurses. On an average, 10 student nurses were given pretest in a day. The planned teaching programme was given to the student nurses on the same day after pretest. Post test was conducted after 10 days by using same questionnaire with same samples. Research proposal was approved by Institutional Ethical Review Board prior to the pilot study and main study. Purpose of the study was explained to subjects. Confidentiality of data collected was assured. A self administered structured questionnaire was used to collect data. It consists of 2 parts.viz, Part I contains socio-demographic data of student nurses. Part II Contains 35 multiple choice questions to assess the knowledge on biomedical waste management. The aspects include understanding importance of biomedical waste management, categories, colour coding, biohazard symbol, methods of segregation, sources, collection, storage, treatment, and disposal of biomedical waste, ill effects of improper waste management, Bio-Medical Waste (Management and Handling) Rule-1998 and role of nurse. Results The data was analysed on the basis of objectives of the study using descriptive and inferential statistics. Section I: Demographic data of the student nurses. Among 60 student nurses, 7(11.67%) were 19 years, 14(23.33%) falls under 20 years, 29(48.33) falls under 21 years, and 10(16.67%) falls under 21 years and above. It was observed that majority 60(100%) were female. Regarding religion of student nurses 43(71.67%) were Hindu, (1.67%) were Muslims, 12(20%) falls under Christian and 3(5%) under Buddhist and 1(1.67%) falls under others. Regarding level of education, 12(20%) were from 2 nd year and 16(26.67%) were from 3 rd years and majority 32(53.33%) were from 4 th year B.Sc Nursing. Regarding source of information, print media40 (60.67%) was the most popular source of information, followed by health professionals 12(20%) and mass media 1(1.67%). Section II: Level of knowledge on biomedical waste management Table 1 depicts that majority of the student nurses 36(60%) had inadequate knowledge, while 24(40%) hade moderately adequate knowledge and none of them had adequate knowledge in pretest. Whereas, none had inadequate knowledge, 2(3.33%) had moderately adequate knowledge and 58(96.66%) had adequate knowledge in posttest. On conclusion, none of the participant had adequate knowledge in pretest, whereas 58(96.33%) had adequate knowledge in post test. Section III: Effectiveness of planned teaching programme on bio-medical waste management The mean posttest knowledge score with SD was significantly higher than the mean pretest knowledge score with SD The obtained t (59) value was 19.5, which is statistically significant at p<0.05 and p<0.01. Hence, it could be concluded that there is significant increase in the knowledge level of student nurses after attending planned teaching programme. 12

13 Table1: Frequency and percentage distribution of level of knowledge on biomedical waste management in pretest and posttest No=60 Level of knowledge Domain Inadequate Moderately Adequate (0-50%) average (50-75%) (>75%) No % No % No % Pretest 36 60% 24 40% 0 05 Posttest 0 0% % % Section III: Association between posttest knowledge and selected demographic variables There was a significant association between demographic variables i.e., age in years, religion, and nationality with post test level of knowledge. This was determined by the chi-square value which was with df 6, with df 6 and with df 1 at p<0.01 and p<0.05 level respectively. Implications Nursing practice: The knowledge about bio-medical waste management enables the student nurses to prepare for working efficiently and competently and thus maintain and improve nursing care. The nurse should wear protective devices while handling the wastes. Regular medical check-up, provision of disinfectant with right quality and Hepatitis B vaccination is essential for the practicing nurses. Nursing education: This study helps to make available resource material related to biomedical waste management. The curriculum should provide adequate clinical experience to student nurses to practice biomedical waste handling and management. The nurse educator can review the study for academic purpose. Nursing administration: Protocols which contains information related to biomedical waste management can be prepared based on WHO and CDC guidelines and it should be displayed in the clinical areas. Nurse administrator should plan and organize teaching programmes, discussions and seminars on biomedical waste management and to motivate student nurses in conducting and attending such programmes. Needle cutter and puncture proof containers should be made mandatory for all health institutes. Biomedical waste management board can be established. The administration should look after segregation of the hospital wastes by using available disposable technology. Nursing Research: As biomedical waste is emerging as a threat to the current health care system, there is a need for extended nursing research on biomedical waste management, to educate the students and staffs for appropriate classification of waste and methods of waste disposal. Research on biomedical waste management helps to provide evidence based nursing care and helps to bring appropriate modification in the waste management. Recommendations 1. An experimental study can be conducted by using control and experimental group in the study. 2. The same study can be undertaken in large samples. 3. A similar study can be replicated on samples with different demographic characteristics. Limitation 1. The study was assessed only knowledge on biomedical waste, practice was not observed. 2. It is a small scale study and limited for a period of 4 weeks. 3. The study did not use control group and randomization Conclusion The study concluded that planned teaching programme was effective in improving knowledge on biomedical waste management. The nursing students during and after completing their studies are at potential risk for hazards due to biomedical waste because of their contact with hospitals. Adequate knowledge about the health hazard of hospital waste and proper methods of handling is necessary to protect themselves, their patients as well as the community from various adverse effects of the hazardous waste. References References are provided upon request. Contact E.mail ID:vathsala.ragavan@gmail.com 13

14 GFATM 7 Nurses Training Project Top Performing SR/SSRs in Top Performing SR- RAK College of Nursing, New Delhi Government College of Nursing, Indore- ranked as the top performing SSR 14

15 JIPMER College of Nursing, Puducherry- ranked 2nd among the SSRs. Vijay Marie College of Nursing, Hyderabad ranked 3nd among the SSRs 15

16 Website: Phone: , Fax: INC Announcements INDIAN NURSING COUNCIL COMBINED COUNCILS BUILDING KOTLA ROAD, TEMPLE LANE, NEW DELHI Mobile Faculty If the nursing teaching Faculty is found more than two times within 3 months they will be issued show cause notice. And has to appear before the ethical committee of INC. Ethical Committee may consider to initiate action against the faculty for cancellation of registration Eligibility Criteria One year experience is waived off for the candidates for admission to Post Basic Diploma programmes. Scheme of Examination All nursing Programmes i.e, ANM, GNM, B.Sc(N), P.B.B.Sc. (N) and M.Sc(N) shall have one regular examination followed by supplementary examination in a year (w.e.f ). The candidates if fail in more than two subjects in any nursing programme they can be promoted to next year. Only two attempts were allowed before 2012 now a candidate can take any number of attempts with a condition that the student completes her course within the maximum period allowed prescribed duration for each nursing programme. That is, M.Sc (N) - 4 years, B.Sc (N) 8 years, GNM = 7 years, ANM = 4 years/ HOWEVER, All papers need to be cleared before appearing in the final year examination. No institution shall submit average internal marks more than 75% i.e., if 40 students are admitted in a course than the average score of the 40 students shall not exceed 75% (w.e.f ). Printed at Rakmo Press Pvt. Ltd. New Delhi