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1. Definition Postnatal care is the care provided to the mother and newborn immediately after delivery up to 6 weeks (puerperium period) to ensure recovery and prevent complications. 2. Purpose To promote recovery of the mother To ensure health and growth of the newborn To detect and manage postpartum complications early To provide health education and family planning advice 3. Indications All mothers after delivery Hospital and home visits High-risk postnatal cases 4. Contraindications ⚠️ No contraindication (essential care for all mothers) 5. Articles / Equipment 🧰 Equipment: BP apparatus Thermometer Stethoscope 🧴 Supplies: Gloves Perineal care items Sanitary pads 📋 Records: Postnatal record chart Mother and child card 6. Patient Preparation Explain procedure to mother Ensure privacy Position mother comfortably Maintain cleanliness 7. Procedure Steps (Step-by-Step Sentences) Wash hands and greet the mother politely. Check identification and review delivery records. Assess general condition of the mother. Measure vital signs (temperature, pulse, respiration, blood pressure). Inspect breasts for engorgement, cracks, or infection. Assess breastfeeding technique and support mother. Examine abdomen for uterine involution (fundal height). Check lochia for amount, color, and odor. Inspect perineum or episiotomy wound for healing. Assess urinary and bowel function. Observe for signs of complications such as fever, bleeding, or pain. Assess emotional status of the mother. Examine the newborn for general condition and feeding. Provide necessary medications if prescribed. Educate mother about hygiene, diet, and newborn care. Advise on family planning methods. Record all findings in postnatal record. Wash hands after completing the procedure. 8. Post Procedure Care Ensure comfort of mother and baby Encourage rest and nutrition Continue breastfeeding support Plan follow-up visits 9. Complications Postpartum hemorrhage Infection (puerperal sepsis) Breast engorgement or mastitis Postpartum depression 10. Health Education Maintain personal hygiene Take balanced diet Continue exclusive breastfeeding Proper perineal care Recognize danger signs: Excessive bleeding Fever Severe abdominal pain Follow-up visits are important 🎯 Viva Questions Q1. What is postnatal period?👉 Up to 6 weeks after delivery Q2. What is lochia?👉 Vaginal discharge after delivery Q3. What is uterine involution?👉 Return of uterus to normal size

1. Definition Antenatal care is the systematic supervision and care of a pregnant woman from conception until the onset of labor to ensure the health of both mother and fetus. 2. Purpose To ensure safe pregnancy and delivery To detect and manage high-risk conditions early To monitor maternal and fetal well-being To provide health education and counseling 3. Indications All pregnant women Routine antenatal visits High-risk pregnancies Community and hospital settings 4. Contraindications ⚠️ No contraindication (ANC is essential for all pregnancies) 5. Articles / Equipment 🧰 Equipment: BP apparatus Stethoscope / Fetoscope Weighing scale Measuring tape 🧴 Supplies: Gloves Urine testing kit Hemoglobin testing supplies 📋 Records: Antenatal card / Mother and child protection card 6. Patient Preparation Explain procedure to mother Ensure privacy Ask mother to empty bladder Position comfortably (lying or sitting) 7. Procedure Steps (Step-by-Step Sentences) Wash hands and greet the pregnant woman politely. Confirm identity and review antenatal records. Take detailed history including obstetric, medical, and family history. Measure and record weight of the mother. Measure blood pressure and record findings. Check for pallor, edema, and general condition. Perform abdominal examination to assess: Fundal height Fetal lie and position Fetal heart rate Auscultate fetal heart sounds using fetoscope or Doppler. Collect urine sample and test for sugar and albumin. Advise laboratory investigations (Hb, blood group, etc.) if required. Administer immunization (e.g., TT injection) as per schedule. Provide iron and folic acid tablets. Educate mother about diet, rest, hygiene, and danger signs. Schedule next antenatal visit. Record all findings in antenatal card. Wash hands after completing the procedure. 8. Post Procedure Care Ensure mother is comfortable Clarify doubts Reinforce health education Plan follow-up visit 9. Complications (If Not Properly Managed) Anemia Preeclampsia Preterm labor Fetal growth restriction 10. Health Education Balanced diet rich in iron and protein Regular antenatal visits Personal hygiene Adequate rest and sleep Recognize danger signs: Severe headache Bleeding Swelling Decreased fetal movements 🎯 Viva Questions Q1. How many antenatal visits are recommended?👉 Minimum 4 visits Q2. What is normal BP in pregnancy?👉 Around 120/80 mmHg Q3. Why is iron given during pregnancy?👉 To prevent anemia

1. Definition Baby bath is a procedure of cleaning the newborn/infant’s body using warm water to maintain hygiene and promote comfort. 2. Purpose To maintain personal hygiene To prevent skin infection To promote comfort and relaxation To improve circulation 3. Indications Routine daily hygiene Soiling of body Before/after feeding (with care) 4. Contraindications ⚠️ Avoid or delay bath in: Immediately after birth (first 24 hours if unstable) Low birth weight or premature baby (risk of hypothermia) Sick or unstable newborn 5. Articles / Equipment 🧰 Equipment: Baby bath tub / basin Water jug 🧴 Supplies: Warm water (37–38°C) Mild baby soap Soft towel Clean baby clothes Diaper 📋 Records: Not usually required (unless hospital setting) 6. Patient Preparation (Baby Preparation) Ensure room is warm and free from air drafts Gather all articles before starting Check water temperature Remove baby clothes gently 7. Procedure Steps (Step-by-Step Sentences) Wash hands thoroughly before handling the baby. Prepare all articles and ensure water is warm (37–38°C). Place the baby on a safe and comfortable surface. Undress the baby gently while maintaining warmth. Clean the eyes using clean cotton swabs from inner to outer canthus. Clean the face without soap. Support the baby’s head and neck securely. Gently pour water over the baby’s body. Apply mild soap and clean the body from head to toe. Pay attention to skin folds such as neck, axilla, and groin. Rinse the body thoroughly with clean water. Clean the genital area from front to back. Lift the baby carefully and wrap in a clean towel. Dry the baby gently, especially skin folds. Dress the baby in clean clothes and diaper. Keep the baby warm and comfortable. Clean and dry all equipment after use. Wash hands after completing the procedure. 8. Post Procedure Care Ensure baby is warm Check for skin rashes or abnormalities Feed the baby if needed Keep baby comfortable 9. Complications Hypothermia Skin irritation Slipping injury Infection (if hygiene is poor) 10. Health Education Use lukewarm water only Avoid harsh soaps Never leave baby unattended Maintain hygiene of bath items Keep bathing time short (5–10 minutes) 🎯 Viva Questions Q1. What is the ideal water temperature for baby bath?👉 37–38°C Q2. Why is baby not bathed immediately after birth?👉 To prevent hypothermia Q3. How are eyes cleaned?👉 From inner to outer canthus

1. Definition Wound dressing is a sterile procedure of cleaning and covering a wound to promote healing and prevent infection. 2. Purpose To promote wound healing To prevent infection To absorb discharge/exudate To protect wound from injury and contamination 3. Indications Open wounds Surgical wounds Infected wounds Burns, ulcers, cuts 4. Contraindications ⚠️ No absolute contraindication, but: Avoid unnecessary frequent dressing Use caution in heavily bleeding wounds (require emergency care) 5. Articles / Equipment 🧰 Equipment: Sterile dressing tray Forceps (cheatle forceps, dissecting forceps) Kidney tray 🧴 Supplies: Sterile gauze pieces Cotton swabs Antiseptic solution (e.g., povidone iodine) Normal saline Adhesive tape / bandage Gloves (sterile and clean) 📋 Records: Patient record sheet 6. Patient Preparation Explain procedure to patient Provide privacy Position patient comfortably Expose only the wound area 7. Procedure Steps (Step-by-Step Sentences) Wash hands thoroughly and prepare all required articles. Explain the procedure to the patient and ensure comfort. Position the patient properly and expose the wound area. Place mackintosh and towel under the wound site. Open the sterile dressing tray using aseptic technique. Wear sterile gloves. Remove the old dressing carefully using forceps. Observe the wound for signs of infection such as redness, swelling, or discharge. Discard the soiled dressing into the kidney tray. Clean the wound using sterile swabs soaked in normal saline. Clean from clean area to dirty area (center to periphery). Use each swab only once and discard it properly. Apply antiseptic solution if prescribed. Allow the wound to dry. Place sterile gauze over the wound. Secure the dressing with adhesive tape or bandage. Make the patient comfortable. Dispose of waste as per biomedical waste guidelines. Remove gloves and wash hands. Document the procedure and findings. 8. Post Procedure Care Check for comfort and pain relief Monitor for bleeding or infection Advise patient not to disturb dressing Schedule next dressing 9. Complications Infection Delayed wound healing Bleeding Pain 10. Health Education Keep dressing clean and dry Do not touch wound with unclean hands Follow proper hygiene Report signs of infection: Redness Swelling Pus Fever 🎯 Viva Questions Q1. In which direction is wound cleaned?👉 From clean to dirty (center to periphery) Q2. Why is aseptic technique important?👉 To prevent infection Q3. What is the purpose of dressing?👉 To promote healing and prevent infection

1. Definition Hypertension is a persistent elevation of arterial blood pressure above normal levels. According to standard guidelines, it is defined as: Systolic BP ≥ 140 mmHg Diastolic BP ≥ 90 mmHg 2. Purpose (Why it is important to assess/manage) To prevent complications like: Heart disease Stroke Kidney damage To maintain normal blood circulation To improve quality of life 3. Indications (When to assess BP for hypertension) Routine health check-up Symptoms like: Headache Dizziness Blurred vision Family history of hypertension Obesity or sedentary lifestyle 4. Contraindications ⚠️ No absolute contraindication for BP measurement, but: Avoid measuring BP on: Arm with injury IV infusion arm Post-mastectomy side 5. Articles / Equipment 🧰 Equipment: Sphygmomanometer (BP apparatus) Stethoscope 🧴 Supplies: Alcohol swab (if needed) 📋 Records: BP chart / patient record 6. Patient Preparation Explain the procedure to the patient Ensure patient is relaxed for 5 minutes Avoid caffeine, smoking, exercise before measurement Position patient: Sitting or lying comfortably Arm at heart level 7. Procedure Steps (Step-by-Step Sentences) Wash hands before starting the procedure. Position the patient comfortably in sitting or lying position. Select the appropriate cuff size for the patient’s arm. Wrap the cuff around the upper arm snugly, about 2–3 cm above the elbow. Palpate the brachial artery to locate pulse. Place the stethoscope over the brachial artery. Inflate the cuff until the pulse disappears and then 20–30 mmHg more. Slowly deflate the cuff at a rate of 2–3 mmHg per second. Note the first sound (Korotkoff sound) as systolic pressure. Note the disappearance of sound as diastolic pressure. Completely deflate the cuff and remove it. Record the reading accurately with arm and position. Wash hands after completing the procedure. 8. Post Procedure Care Inform patient about BP reading Advise rest if BP is high Repeat measurement if needed Document findings 9. Complications Stroke Heart attack Kidney failure Vision problems 10. Health Education Reduce salt intake Maintain healthy weight Regular exercise Avoid smoking and alcohol Take medications regularly Regular BP monitoring 🎯 Viva Questions Q1. What is normal BP?👉 120/80 mmHg Q2. What is hypertension?👉 BP ≥ 140/90 mmHg Q3. Which artery is used for BP measurement?👉 Brachial artery

1. Definition Bag technique is a scientific method of using and handling the community health nursing bag to prevent infection and cross-contamination during home visits. 2. Purpose To maintain asepsis in community setting To prevent cross infection between patients To ensure safe and organized nursing care To protect both patient and nurse 3. Indications During home visits While providing community-based nursing care For procedures like dressing, injection, newborn care, etc. 4. Contraindications ⚠️ No absolute contraindication, but: Avoid placing bag on dirty or contaminated surfaces Avoid use if bag is unclean or improperly packed 5. Articles / Equipment 🧰 Bag Contains: Sterile dressing articles Syringes and needles Medicines Cotton, gauze, bandages Thermometer, BP apparatus 🧴 Supplies: Soap Hand sanitizer Clean towel Plastic sheet or newspaper 📋 Records: Family folder Register Pen 6. Patient Preparation Explain the procedure to patient/family Ensure privacy Select a clean area in home Gain cooperation of family members 7. Procedure Steps (Step-by-Step Sentences) Wash hands before entering the patient’s home. Greet the patient and introduce yourself politely. Select a clean and dry area to place the bag. Spread a clean plastic sheet or newspaper on a flat surface. Place the nursing bag on the clean sheet. Open the bag carefully without touching the inner contents unnecessarily. Remove only the required articles from the bag. Close the bag immediately after taking out needed items. Perform hand hygiene before starting the procedure. Carry out the nursing procedure using aseptic technique. Avoid placing used articles back inside the bag directly. Clean and disinfect reusable articles before returning them to the bag. Dispose of waste properly as per biomedical waste guidelines. Wash hands after completing the procedure. Repack the bag neatly and close it properly. Thank the patient and provide health education if needed. 8. Post Procedure Care Ensure all articles are cleaned and arranged Maintain cleanliness of bag Record procedure in register Plan follow-up visit 9. Complications Cross infection due to poor technique Contamination of bag contents Spread of communicable diseases 10. Health Education Maintain home cleanliness Follow hygiene practices Proper waste disposal Importance of infection prevention 🎯 Viva Questions Q1. What is bag technique?👉 A method to prevent infection during home visits Q2. Why is plastic sheet used?👉 To prevent contamination of the bag Q3. When is bag technique used?👉 During community/home visits

1. Definition Steam inhalation is a therapeutic procedure in which warm moist air is inhaled to relieve respiratory congestion and improve airway clearance. 2. Purpose To relieve nasal and chest congestion To loosen thick secretions To soothe inflamed respiratory mucosa To improve breathing 3. Indications Common cold Sinusitis Bronchitis Upper respiratory tract infections Dry cough with congestion 4. Contraindications ⚠️ Avoid or use caution in: Unconscious patient Severe respiratory distress Small children without supervision (risk of burns) High fever 5. Articles / Equipment 🧰 Equipment: Steam inhaler / bowl Towel 🧴 Supplies: Hot water Optional: medicated solution (e.g., eucalyptus oil) 📋 Records: Patient record sheet 6. Patient Preparation Explain the procedure to the patient Position patient in sitting position Instruct patient to remove tight clothing Ensure patient comfort and privacy 7. Procedure Steps (Step-by-Step Sentences) Wash hands thoroughly before starting the procedure. Prepare hot water and pour it carefully into a steam inhaler or bowl. Add prescribed medication (if ordered) to the hot water. Place the inhaler or bowl on a stable surface. Position the patient comfortably in a sitting position. Instruct the patient to lean over the inhaler or bowl. Cover the patient’s head with a towel to trap the steam. Instruct the patient to inhale the steam slowly and deeply through the nose and mouth. Continue the procedure for 10–15 minutes. Observe the patient for any discomfort, dizziness, or difficulty in breathing. Stop the procedure if the patient feels uncomfortable. Remove the towel and allow the patient to rest. Wipe the face and provide comfort. Clean the equipment properly after use. Wash hands after completing the procedure. 8. Post Procedure Care Keep patient warm and comfortable Advise rest Encourage fluid intake Document the procedure 9. Complications Burns due to hot water Dizziness or fainting Increased breathing difficulty (rare) 10. Health Education Avoid very hot steam (prevent burns) Take steam inhalation 2–3 times daily if advised Maintain hydration Avoid exposure to cold air immediately after procedure 🎯 Viva Questions Q1. What is the purpose of steam inhalation?👉 To relieve congestion and loosen secretions Q2. What is the duration of steam inhalation?👉 10–15 minutes Q3. What is the main risk in steam inhalation?👉 Burns

1. Definition Oral Rehydration Therapy is a simple and effective method of replacing fluids and electrolytes lost during diarrhea using Oral Rehydration Solution (ORS). It is recommended by the World Health Organization for prevention and treatment of dehydration. 2. Purpose To prevent and treat dehydration To replace fluid and electrolyte loss To reduce complications of diarrhea To maintain normal body functions 3. Indications Diarrhea (acute or chronic) Mild to moderate dehydration Vomiting with fluid loss Children and adults with fluid imbalance 4. Contraindications ⚠️ Avoid or use cautiously in: Severe dehydration (needs IV fluids) Persistent vomiting Unconscious patient Intestinal obstruction 5. Articles / Equipment 🧰 Equipment: Clean container or glass Spoon 🧴 Supplies: ORS packet Safe drinking water (boiled and cooled) 📋 Records: Intake-output chart 💧 Composition of ORS (Oral Rehydration Solution) Standard WHO low-osmolarity ORS contains the following components: Glucose (Anhydrous) – 13.5 g Sodium Chloride (NaCl) – 2.6 g Potassium Chloride (KCl) – 1.5 g Trisodium Citrate Dihydrate – 2.9 g 👉 All dissolved in 1 liter of clean water 💧 ORS Requirement Chart (According to Age) Age Group ORS Amount After Each Loose Stool Method of Administration Below 2 years 50 – 100 ml Spoon / dropper, small frequent sips 2 – 10 years 100 – 200 ml Cup, slow intake Above 10 years & Adults 200 – 250 ml or as much as tolerated Drink freely in small sips 6. Patient Preparation Explain procedure to patient or caregiver Ensure patient is conscious and able to drink Assess degree of dehydration Wash hands before preparation 7. Procedure Steps Wash hands thoroughly before preparing ORS solution. Take one liter of clean, boiled, and cooled drinking water in a clean container. Open one ORS packet carefully without contaminating it. Pour the entire contents of the ORS packet into the water. Stir the solution well until the powder is completely dissolved. Do not add sugar, salt, or any other substances to the solution. Check the solution for proper mixing and clarity. Give the ORS solution to the patient in small, frequent sips using a cup or spoon. Encourage the patient to drink after each loose stool. If vomiting occurs, wait for a few minutes and continue giving ORS slowly. Monitor the patient for signs of improvement such as reduced thirst and better urine output. Continue ORS therapy as per requirement (usually within 24 hours). Discard any unused ORS solution after 24 hours. Wash hands after completing the procedure. 8. Post Procedure Care Continue feeding (especially breastfeeding in infants) Monitor hydration status Maintain intake-output record Refer if condition worsens 9. Complications Severe dehydration if ORS is inadequate Electrolyte imbalance (rare if properly used) Continued diarrhea 10. Health Education Use ORS at home during diarrhea Prepare ORS correctly (1 packet in 1 liter water) Maintain hygiene and safe drinking water Continue normal diet Recognize danger signs: Sunken eyes Lethargy No urine output Persistent vomiting 🎯 Viva Questions Q1. What is the correct ratio for ORS preparation?👉 1 packet in 1 liter of water Q2. When should ORS solution be discarded?👉 After 24 hours Q3. Can ORS be given in severe dehydration?👉 No, IV fluids are required

1. Definition Urine sugar test is a diagnostic procedure used to detect the presence of glucose in urine. It helps in assessing carbohydrate metabolism and screening for conditions like Diabetes Mellitus. 2. Purpose To detect glycosuria (glucose in urine) To screen for diabetes mellitus To monitor blood glucose indirectly To assess renal threshold for glucose 3. Indications Suspected diabetes mellitus Routine health check-up Monitoring known diabetic patients Symptoms like: Polyuria Polydipsia Polyphagia 4. Contraindications ⚠️ No absolute contraindications, but: Avoid contaminated urine sample Avoid prolonged standing urine (false results) 5. Articles / Equipment 🧰 Equipment: Test tubes Test tube holder Spirit lamp/Bunsen burner Dropper 🧴 Supplies: Benedict’s solution Urine sample (fresh) Gloves 📋 Records: Lab report sheet 6. Patient Preparation Explain procedure to patient Collect fresh urine sample in clean container Prefer midstream urine sample No special dietary restriction required (unless ordered) 7. Procedure Steps Wash hands thoroughly and wear clean gloves to maintain aseptic technique. Collect a fresh urine sample in a clean and dry container using midstream method. Take a clean test tube and pour about 5 ml of Benedict’s solution into it. Hold the test tube with a holder and heat the solution over a flame until it starts boiling. Remove the test tube from the flame carefully. Add 8–10 drops of the urine sample into the test tube using a dropper. Mix the contents gently by shaking the test tube. Heat the test tube again for 2–3 minutes. Allow the test tube to cool down slowly. Observe the color change in the solution carefully. Compare the color with standard chart to interpret the result. Record the findings accurately in the patient record. Discard the urine sample safely and clean all equipment. Remove gloves and wash hands properly after the procedure. 🔷 Interpretation of Result Color Change Result Blue (no change) No sugar (Normal) Green Trace sugar Yellow + (mild) Orange ++ (moderate) Brick red +++ (high sugar) 8. Post Procedure Care Discard urine sample safely Clean and sterilize equipment Remove gloves and wash hands Record results clearly 9. Complications / Errors False positive due to: Drugs (e.g., Vitamin C) False negative due to: Dilute urine Improper heating technique Contaminated sample 10. Health Education Maintain proper diabetic diet Regular monitoring of urine/blood sugar Importance of medication compliance Encourage lifestyle modification: Exercise Weight control Recognize symptoms of high sugar 🎯 Viva Questions Q1. Which solution is used in urine sugar test?👉 Benedict’s solution Q2. What does brick red color indicate?👉 High sugar in urine Q3. What is glycosuria?👉 Presence of glucose in urine

1. Definition Newborn assessment is a systematic examination of a baby immediately after birth and during the neonatal period to evaluate adaptation to extrauterine life. It includes physical examination, vital signs, reflexes, and behavioral responses. 2. Purpose To assess general health status of the newborn To detect congenital abnormalities early To evaluate adaptation to extrauterine life To identify risk conditions requiring immediate care To establish baseline data for future comparison 3. Indications Immediately after birth (within first hour) Before discharge from hospital During routine postnatal visits In sick or high-risk newborns During home visit in community settings 4. Contraindications ⚠️ There are no absolute contraindications, but: Delay assessment in severely unstable newborn Avoid excessive handling in: Respiratory distress Premature babies (risk of hypothermia) 5. Articles / Equipment 🧰 Equipment: Stethoscope Thermometer Infant weighing scale Measuring tape Watch with second hand 🧴 Supplies: Clean gloves Warm cloth/towel Hand sanitizer 📋 Records: Newborn assessment chart APGAR score sheet 6. Patient Preparation (Newborn Preparation) Ensure warm environment (prevent hypothermia) Wash hands and maintain aseptic technique Place baby on warm, clean surface Ensure baby is calm (preferably after feeding) Explain procedure to mother 7. Procedure Steps 🔷 Initial Observation Check cry → strong/weak Observe color → pink (normal), cyanosis (abnormal) Note posture and activity 🔷 Vital Signs Temperature: 36.5–37.5°C Heart Rate: 120–160/min Respiratory Rate: 30–60/min 🔷 Anthropometric Measurements Weight: 2.5–4 kg (normal) Length: 48–52 cm Head circumference: 33–35 cm Chest circumference: 30–33 cm 🔷 Head to Toe Examination 👶 Head Check shape, fontanelles (anterior & posterior) Molding/caput (normal in birth) 👀 Eyes Symmetry, discharge, redness 👂 Ears Position and shape 👃 Nose Patency (check breathing) 👄 Mouth Check cleft lip/palate 🔷 Chest Symmetry of chest movement Breath sounds (clear/abnormal) 🔷 Heart Auscultate for heart sounds and murmurs 🔷 Abdomen Soft, no distension Umbilical cord: 3 vessels (2 arteries, 1 vein) 🔷 Genitalia Male: testes descended Female: normal structure 🔷 Limbs Check movement and deformities Count fingers and toes 🔷 Skin Color, birth marks, rashes Check for jaundice 🔷 Reflexes Moro reflex Rooting reflex Sucking reflex Grasp reflex 🔷 APGAR Scoring (at 1 & 5 minutes) A + P + G + A + R Appearance, Pulse, Grimace, Activity, Respiration Score: 7–10 (normal), 4–6 (moderate), 0–3 (severe distress) 8. Post Procedure Care Keep baby warm and dry Return baby to mother (skin-to-skin contact) Encourage early breastfeeding Clean and arrange equipment Document findings properly 9. Complications (If Abnormalities Found) Respiratory distress Congenital anomalies Hypothermia Neonatal jaundice Infection signs 10. Health Education Importance of exclusive breastfeeding Maintain warmth (kangaroo care) Cord care (keep clean and dry) Recognize danger signs: Poor feeding Fever or cold body Fast breathing Yellow discoloration Advise regular follow-up 🎯 Viva Questions (Important) Q1. What is normal heart rate of newborn?👉 120–160 beats/min Q2. What is APGAR score used for?👉 To assess newborn’s condition immediately after birth Q3. Name any two newborn reflexes.👉 Moro reflex, Rooting reflex

For 1st Year B.Sc Nursing (INC Syllabus)

Detailed Nursing Foundations Notes (1st Year B.Sc Nursing – INC)