Fillable Nursing Student Health Statement (Indian Hills Community College)

Fill Online, Printable, Fillable, Blank Nursing Student Health Statement (Indian Hills Community College) Form

Use Fill to complete blank online INDIAN HILLS COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Nursing Student Health Statement (Indian Hills Community College)

On average this form takes 4 minutes to complete

The Nursing Student Health Statement (Indian Hills Community College) form is 2 pages long and contains:

  • 2 signatures
  • 0 check-boxes
  • 6 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Indian Hills Community College

BROWSE INDIAN HILLS COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Student Health Statement
Nursing Program
Student Academic Role and Clinical Performance Requirements:
All nursing students must be physically, emotionally, and academically able to safely demonstrate completion
of all required learning activities, and achieve all required clinical and course objectives in order to successfully
complete the nursing program curriculum within time limits. Students with physical, mental, or emotional
limitations indicating need for special accommodation should schedule an appointment with the Success Center.
This appointment should be made at the beginning of the nursing educational experience and as needed to
review methods to assist the student. Nursing students will be expected to provide nursing care regardless of race,
color, national lifestyle, or health problem. This expectation is consistent with the American Nurses’ Association
code of Ethics.
Nursing students will be in clinical courses requiring the safe application of both gross and fine motor skills, and
complex critical thinking skills as an inherent element of nursing practice. Usual and required activities routinely
conducted by students include care for clients that may be ambulatory or comatose, and involves all age ranges
from premature infants to geriatric clients. Students must be able to safely perform at least the following clinical
skills: physical assessment (inspection, palpation, percussion, auscultation); hygiene management; management
and assisting with client mobility and transfer, wound management; medication administration via various routes;
and some invasive procedures. Required abilities are: walking, standing, bending, turning, reaching, talking,
listening, visual inspection, and moderate to heavy lifting. There always exists potential exposure to communicable
and sexually transmitted diseases and other pathogens.
STUDENT INSTRUCTIONS:
I understand the student academic role and clinical performance requirements and agree that I have the primary
responsibility for my own health status. I agree that I will not knowingly place clients, others or myself in unsafe
situations based upon my physical, mental, or emotional limitations. I have completed and signed the Physical
Abilities Requirements form on the back of this page.
Name:
Signature: Date:
NOTE: This form with the student’s signature is required at the beginning of the nursing program and upon
return to clinical following absence due to health problems or changes in health status that have the potential to
influence patient/nurse safety and aect the quality of care provided by the nursing student.
click to sign
signature
click to edit
Student Name Nursing Student Physical Abilities Requirements Form
R-Regularly O-Occasionally
Abilities R O Measurable Descriptor
Vision X Ability to read syringes, labels, instructions on equipment, CRT
Color Vision X Assessment of skin, drainage, color of blood
Hearing X Auscultation (evaluation of sounds) of lungs, heart, abdomen
Sense of Touch X Assessment of skin texture, lumps, moisture
Sense of Smell X Assessment of patients, drainage, skin, and body odors
Finger Dexterity X Manipulation of tubing, equipment
Temperature Discrimination X Assessment of temperature for hot/cold treatments
Intelligible Oral Communication X Reports collaboration with instructor, patient teaching
Pushing X lbs/ft 100 lbs equipment, beds with and without patients
Pulling X lbs/ft 50 lbs equipment, beds, repositioning patients
Lifting X lbs/ft 50 lbs patients, equipment and supplies
Floor to Waist X lbs/ 50 lbs 3 man lift of patients
12” to Waist X lbs/ 50 lbs 3 man lift
Waist to Shoulder X lbs/ 30 lbs equipment and supplies
Shoulder to Overhead X lbs/ 10 lbs equipment and supplies
Reaching Overhead X Ht/lbs Overhead equipment, IV therapy
Reaching Forward X Ft : Use of equipment, patient care activities
Carrying X Ft 44 lbs Bedside commode, equipment and supplies
Standing X For long periods of time, drawing up and dispensing medications
Sitting X Infrequent: Short periods. Charting
Squatting X Infrequent, short periods. Measuring and collecting urinary and wound drainage.
Stooping X Infrequent, short periods. Adjusting equipment for patients
Kneeling X Infrequent; Re-set equipment
Walking X Frequent, long periods of time; rounds, walking patients
Running X Infrequent, Emergency situations
Crawling X Infrequent, short periods; reset or adjust bed settings
Climbing X Infrequent; patient care activities
Stairs(ascending and descending) X Infrequent; Emergency situations
Turning (head/neck) X Frequent, short periods; Nursing Actions
Repetitive Leg/arm movement X Frequent, short periods; Use of Equipment
Use of Foot or Hand Controls X Frequent, short periods; Use of equipment
I have read, understand and accept the above working conditions expected of a nursing student.
I do not need accommodations to perform the physical duties.
I feel the following accommodations are needed to perform the physical duties.
Signature: Date:
Revised: Fall 2007
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Nursing Student Health Statement (Indian Hills Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document