PAKISTAN NURSING COUNCIL ISLAMABAD

ANNUAL RETURN FORM

FOR PUBLIC HEALTH NURSING SCHOOL

1. Name of Institution:

2. Full Postal Address

3. Telephone No ______________ 4. Date of Establishment: __________

5. Type of institution: Fed Govt. q Pro. Govt. q Autonomous q Armed Forces q Private q

6. Type of programme offered _________ Others (Specify) _________

7 Infrastructure of Institute as prescribed by PNC rules and regulations

Number Capacity to accommodate Furniture /Fixtures

7.1 Office of Principal

7.2 Office of Vice-Principal
7.3 Offices of the faculty members
7.4 Office of the Ministerial Staff
7.5 Lecture Hall
7.6 Demonstration Room / skill lab
7.7 Audio-Visual Room
7.8 Auditorium
7.9 Science Laboratory
7.10 Computer lab
7.11 English language lab
7.12 Library
7.13 Tuck shop/cafeteria
7.14 Lavatory
7.15 Faculty meeting room

(Attach the list of furniture)

8. There is a separate budget for PHNS q Yes q No

8.1 Attach last year budget (and expenditure)
8.2 Name of Drawing and disbursing Officer

9. Transportation
9.1 Is vehicle available for Principal and teaching staff for official use q Yes q No
9.2 Is vehicle available for students q Yes q No
qVehicles are from central pool q Vehicles belong to School q other source

10. Components of Curriculum

10.1 Philosophy/mission
10.2 Program goals
10.3 Learning Outcome - Level and terminal objectives

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11. Programme overview
11.1 Course sequence: list courses taught in each year
11.2 Course descriptions, objectives, outlines (make available at time of inspection)
11.3 Teaching learning strategies: (course plans, class schedules, lesson plans, and assignments)
11.4 Formative and summative assessments of students.

12. Quantity and quality of faculty members. Please fill the attached Performa of teaching staff.
Faculty development plan: provide list of faculty on study leave
Continuing education session provide list of faculty and session taught

Teaching Staff
S.No Designation BPS Sanction Post Filled Vacant Reg No Remarks

12.1 Principal

12.2 Vice Principals

12.3 WMO

12.4 Nursing Instructors

12.5 Clinical Instructor

12.6 Public health Nurse

Supervisor
12.7 Midwifery Supervisor

12.8 Lady Health Visitor’s

12.9 Dai’s

12.10 English Teacher ( M A

Eng) Part Time

13. Remuneration of lecturers (Part timer)

Monthly Per Lecture
13.1 How are the lecturers paid?
13.2 How much they are paid? Rs._________ Rs.________

14. Ministerial staff required for the school:

S.# Designation BPS Sanctioned Post Filled Vacant Remarks

14.1 Office Supdt.

14.2 Assistant

14.3 Computer operator

14.4 Senior clerk

14.5 Junior clerk

15. Learning Resources, please provide the list of the following:

e.g. library, text books, relevant books, reference books, and journals, audio visual aids such as models charts,
equipment and mannequins , Internet Facilities available

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16. Academic calendar
17.1 Term and or semester systems? Class schedule copy
17.2 Allocated hours for each course and classes taught.

17. Academic policies

17.1 Provide examination record of the current year of students

18. Evaluation criteria for programme, courses, faculty and clinical facilities
18.1 Provide examples of filled evaluation forms.

19. Information management System

Record keeping of incoming students, analysis of trends and statistics
Examinations and progress of students – transcripts

19.1 Attendance Register q Yes q No

19.2 Academic Record q Yes q No
19.3 Clinical Record q Yes q No
19.4 Health Record q Yes q No

20. Statistical Data of students for last 3 years:

Statistics Number of students

Yr. 200 Yr. 200 Yr. 200
P F D P F D P F D
20.1 Admitted in last 3 years

20.2 Passed in PTS

20.3 First year Examination (NEB)
Final Year Examination(NEB

21. Selection of the Students:

21.1 Age of entry in years: _____________

21.2 Minimum
21.3 Maximum
21.4 Number of sanctioned seats
21.5 Number of students in training _____________
21.6 Annual Intake _____________

22. Selection Committee:

22.1 Composition of selection Committee
(a) _________________________________
(b) _________________________________
(c) _________________________________
(d) _________________________________
(e) _________________________________

22.2 Mode of Selection:

a. Merit q Yes q No
b. Written Test q Yes q No
c. Interview q Yes q No

22.3 Which month does the introductory (P.T.S.) period begin?

22.4 Length of introductory (PTS) training period? ______________

23. Existence of Committees:

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 23.1 Academic Committee q Yes q No
23.2 Selection Committee q Yes q No
23.3 Discipline Committee q Yes q No
23.4 Mess Committee q Yes q No
23.5 Social/Recreation Committee q Yes q No
23.6 Others, please specify q Yes q No

(NOTE: Evidence of activities and minutes of the meeting of above mentioned committees to be attached)

24. Teaching Program of institute:

24.1 Are conferences /meetings held regularly between?
24.1.1 Teaching staff and students (Pre & Post) q Yes q No
24.1.2 Nursing staff and students q yes q No
24.1.3 Nursing Staff and Teaching Staff q Yes q No
24.2 Medical Staff give clinical teaching to students q Yes q No
24.3 How many hours per week students spend time in learning in the hospital?

NOTE: Schedule of Instructors for clinical supervision/Teaching (Attach Copy)

25. Field Visits:

Students are taken for field visits according to prescribed curriculum q Yes q No
(Attach the list of sites)

26. Clinical Experience for midwifery:

26.1. Does the hospital meet the required basic criteria as prescribed by PNC?
26.2. Is the school affiliated with one or more hospitals?
If so: -
26.2.1 Name of hospital
26.2.2Clinical area utilized for learning experience by the students
26.2.3 Size of the unit
26.2.4 Are any of the units of the hospital/institution under inspection being
used by other hospitals/institutions for gaining experience?
If so, please give brief details:

27. Number of beds:

Total Female Children

No. of Non-paying beds No. of Paying beds

28 Beds Allocation:
Sanctioned Beds Average occupancy last
month
28.1 Pre-natal
28.2 Labour
28.3 Post Natal
28.4 Gynae
28.5 Isolation
28.6 Eclampsia
28.7 Nursery
a. Normal
b. Sick babies
c. Isolation babies
28.8 Deliveries Normal Forceps/Vacu Caesarian
um

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 a Last month
b Last year
28.9 Out-Patients Dept. Daily average Monthly average Yearly

28.9.1. Pre-Natal
28.9.2. Post Natal
28.9.3. Gynae
28.9.4 Obs
28.9.5. Immunization
28.9.6. Infertility
28.9.7. Family Planning

29.
Operation Theatres Daily No. of operations performed
Number during last year
29.1 General Theatres for (Obstetric Surgery __________________
29.2 General Theatres for (Gynae Surgery) __________________
30. Arrangement for domiciliary services/training (attach annexure)

30.1 # domiciliary case in community

30.2 visit report by Midwife.
30.3 Antenatal cases
30.4 Primigravida cases.
30.5 Multigravida
30.6 Hospital confinement
30.7 Home deliveries
30.8 Postnatal visit Record
30.9 New born EPI status

31. Present hours of duty Broken Shift Straight

31.1 Trained Staff
31.2 Nurse patient ratio

32. Clinical experience available: with attached MCH centre

A) Physical facilities of MCH

Offices yes no
Doctor office (WMO)
Nursing Supth
LHVs
Domiciliary Mid-supervisor
Dispensary
Sitting area for mother & children
Well baby clinic,
Labour/examination room
Vaccination room, Lab,
Dai training room
Family planning
Record room

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 Lavatory for staff /patient
Optional day care nursery with
lavatory for infant, toddles

Each MCH centre should Target population 25000 to 30000

b) Function of MCH center
MCH Community
Normal deliveries
Community Health Services
Schedule of post natal visits
Activities of LHV during post natal cases
Observation within 72 hours bleeding
Management of breast feeding
Follow up postnatal visit
Immunization (campaign)
Feeding/ cord care teaching
Advise for diet of mother
Advise on birth spacing Family planning
Early ambulation and Post Natal exercises
Record of Maternal, Neonatal, infant, mortality cases

33. Transport for community services available for student and staff for 24hrs

qYes q No

34. Student residence:

34.1 Accommodation:
In hostel Out of hostel
34.1.1 Total number of students living
34.1.2 How many share a room? (Approx. size
34.1.3 How many share a bath room?
34.1.4 Is there a student common room
34.1.5 Is there a student dinning room yes no
34.1.6 is there a student’s visitor’s room yes no
34.1.7 What are the visiting days
34.1.8 Are there adequate recreational facilities available
34.1.9 Are there adequate recreational equipment facilities
34.1.10 Are the living conditions satisfactory poor

34.2 what is the distance between the hospital and the hostel

35. Accommodation for Single female teaching staff:

35.1 Is there hostel accommodation available? q Yes q No
35.2 Is it furnished according to the list furnished by PNC? q Yes q No

36. Accommodation for the married Nursing staff q Yes q No

36.1 How many houses are allocated for Nursing Faculty?
36.2 How many actually living?

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 36.3 Is official transport available?
36.4 Is accommodation provided according to the grades?

37. Furnished Accommodation & Services:

Is free furnished accommodation with free electricity, gas and water as well as free services of servants being
provided to the Student who is living in the hostel?
38. Annexure required to be attached:

1. List of Nursing Personnel in clinical area

2. Rules & Regulations for the hostel
3. Sample Menu for a week.
4. Blank student health record card.
5. Weekly class schedules of students of all classes.
6. Formal teaching hours. schedule

Name of the Principal: Signature of Principal

OFFICIAL STAMP

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 Performa of Nursing Faculty Members
S. Name Designation Reg No Qualification
#

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