Maharashtra HSC NSQF Healthcare GDA cheat sheet

The General Duty Assistant (GDA) provides basic, non-invasive patient care under the supervision of a registered nurse or physician; the GDA does not diagnose, prescribe, or perform invasive procedures.

Core GDA duties: bathing and grooming, oral care, feeding and hydration support, toileting and elimination assistance, bed-making, positioning and turning, ambulation assistance, vital-sign recording, and specimen collection guidance.

The Indian healthcare delivery system is organised in tiers: sub-centre (population ~5,000), Primary Health Centre (~30,000), Community Health Centre (~1,20,000), and district/sub-district hospitals.

National Health Policy 2017 and the National Health Mission set the framework for public health delivery; Ayushman Bharat (2018) adds Health and Wellness Centres and the PM-JAY insurance scheme.

The GDA's scope is defined by the facility's duty roster and standing orders; any task outside training (e.g., IV cannulation, drug administration) must be referred to a qualified nurse.

Handover (shift report) follows a structured format such as SBAR: Situation, Background, Assessment, Recommendation.

Chain of command in a ward: GDA → staff nurse → nursing supervisor/ward in-charge → medical officer → nursing superintendent.

Infection risk to the GDA is highest during bed-making, linen handling, and body-fluid contact; PPE selection is based on the anticipated exposure, not the patient's diagnosis.

Anatomical position: standing erect, face forward, arms at sides with palms forward; all directional terms (superior/inferior, anterior/posterior, medial/lateral, proximal/distal) are referenced to it.

Body cavities: cranial (brain), thoracic (heart, lungs), abdominal (GI organs, liver, spleen), pelvic (bladder, rectum, reproductive organs); the diaphragm separates thoracic from abdominal.

Skeletal system: 206 bones in an adult; axial skeleton (skull, vertebral column, rib cage) = 80 bones, appendicular skeleton (limbs, girdles) = 126 bones.

Normal adult vital-sign reference ranges: temperature 36.1–37.2 °C oral, pulse 60–100/min, respiration 12–20/min, blood pressure <120/<80 mmHg, SpO2 ≥95% on room air.

Blood flow through the heart: right atrium → tricuspid valve → right ventricle → pulmonary valve → lungs → pulmonary veins → left atrium → mitral valve → left ventricle → aortic valve → aorta.

Common chronic conditions and key markers: diabetes mellitus (fasting glucose ≥126 mg/dL, HbA1c ≥6.5%), hypertension (≥140/90 mmHg), COPD (FEV1/FVC <0.70 post-bronchodilator), anaemia (low haemoglobin: adult male <13 g/dL, female <12 g/dL).

Cardinal signs of inflammation: redness (rubor), heat (calor), swelling (tumour), pain (dolor), loss of function (functio laesa).

Dehydration signs in an older adult: dry mucous membranes, reduced skin turgor, concentrated urine, confusion, tachycardia, postural hypotension.

Chain of infection: infectious agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host; breaking any link prevents transmission.

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, PPE, safe injection practices, safe handling of sharps and body fluids, and environmental cleaning.

Transmission-based precautions: contact (e.g., MRSA, scabies, C. difficile), droplet (e.g., influenza, pertussis, meningococcus - mask within 1 m), airborne (e.g., TB, measles, varicella - N95 plus negative-pressure room).

Sequence for donning PPE: gown → mask/respirator → goggles/face shield → gloves. Sequence for doffing: gloves → goggles/face shield → gown → mask/respirator; hand hygiene after doffing.

Spill management: contain with absorbent material, flood with 1% sodium hypochlorite for blood/body fluids (or per facility policy), leave for the contact time, then remove wearing gloves and clean the area.

Sharps safety: never recap by two-handed technique, never bend or break needles, place sharps immediately into a puncture-resistant container filled to no more than three-quarters.

Post-exposure prophylaxis for a needle-stick injury: wash with soap and water, do not squeeze the wound, report immediately, and start HIV PEP ideally within 2 hours (maximum 72 hours); baseline serology for HIV, HBV, HCV.

Isolation room requirements: door closed for airborne precautions, dedicated equipment, and a sign at the entrance listing the precautions required.

WHO 5 Moments for Hand Hygiene: (1) before touching a patient, (2) before a clean/aseptic procedure, (3) after body-fluid exposure risk, (4) after touching a patient, (5) after touching patient surroundings.

Hand-rub (alcohol-based) steps per WHO: apply a palmful, rub palms, backs of hands, interlace fingers, backs of fingers to opposing palms, rotational thumbs, fingertips, then wrists; total duration 20–30 seconds.

Soap-and-water handwashing lasts 40–60 seconds; it is mandatory when hands are visibly soiled or after exposure to spore-forming organisms such as C. difficile.

Biomedical waste colour coding (Biomedical Waste Management Rules, 2016): yellow - human/animal anatomical waste, soiled waste, expired/discarded medicines, chemical and cytotoxic waste; red - contaminated recyclable plastic and tubing; white (translucent) - sharps (needles, syringes, scalpel blades); blue - glassware and metallic implants.

Yellow-bag waste is incinerated or plasma-pyrolysed; red-bag waste is autoclaved or microwave-treated before recycling; sharps are needledestroyed and encapsulated in a sharps pit or sent for final disposal.

General waste (food scraps, paper, packaging) goes into green bins; it is not biomedical waste and must not be mixed with infectious waste.

Bags are filled to no more than three-quarters capacity, tied securely, labelled with the facility name, date, waste category, and bar code where applicable; storage before transport is limited to 48 hours.

Needle-stick prevention: use needle-free or safety-engineered devices where available, keep sharps containers at the point of use, and never overfill or force items into the container.

Pressure-injury risk is assessed with the Braden Scale (six subscales: sensory perception, moisture, activity, mobility, nutrition, friction/shear); a lower score means higher risk.

Repositioning schedule for an at-risk or immobile patient: turn and reposition at least every 2 hours, with skin inspection at each turn; 30-degree lateral tilt is preferred over full lateral.

Common safe positions: supine (flat), semi-Fowler's (head 30–45°), Fowler's (head 45–60°), high-Fowler's (90°), lateral/side-lying, prone, and Trendelenburg (head-down; contraindicated in raised intracranial pressure).

Log-roll technique: align the patient's arms across the chest, cross the far leg over the near leg, and roll the trunk and hips as one unit to protect the spine; use for spinal injury, post-surgical, and heavy patients.

Fall risk screening uses a validated tool such as the Morse Fall Scale; interventions include bed in the lowest position, brakes locked, side rails up, call bell within reach, non-slip footwear, and adequate lighting.

Safe transfer: lock the bed or chair brakes, raise the bed to hip height, stand close to the patient, use a gait belt, and instruct the patient to push up on the armrests; never lift the patient by the arms or axillae.

Ambulation: check orthostatic status (ask the patient to sit at the edge of the bed for one minute before standing), use a gait belt, walk on the patient's weaker side, and keep a chair behind them.

Post-fall protocol: do not move the patient immediately, check for injury, assess consciousness and vital signs, notify the nurse/doctor, document the event, and complete an incident report.

Temperature sites: oral (3 minutes for a glass thermometer), axillary (add 0.5 °C to approximate oral), rectal (subtract 0.5 °C), tympanic; oral is contraindicated after hot/cold fluids, in unconscious or convulsing patients, and in mouth-breathing patients.

Pulse is counted for a full 60 seconds at the radial artery, noting rate, rhythm, and volume; a pulse deficit is the difference between the apical and radial rates.

Respirations are counted for 60 seconds without telling the patient, observing rate, depth, rhythm, and character; normal adult rate is 12–20 per minute.

Blood pressure: patient seated and rested for 5 minutes, arm supported at heart level, cuff bladder encircling 80% of the arm, deflate at 2–3 mmHg per second; record systolic/diastolic.

Pulse oximetry: SpO2 <90% is significant; nail polish, cold extremities, poor perfusion, and motion can cause false low readings.

Pain is the fifth vital sign; use a 0–10 numeric rating scale for adults, the Wong-Baker FACES scale for children, and PAINAD for patients with dementia who cannot self-report.

Blood glucose monitoring: clean the finger with soap and water (or alcohol, fully dried), wipe away the first drop, and use the second drop for the test; record the value and time relative to meals.

Urine output: normal adult output is roughly 0.5–1 mL/kg/hour; output below 30 mL/hour for adults should be reported as possible oliguria.

Bed bath sequence: face and neck → arms and axillae → chest and abdomen → legs → back and buttocks → perineal area; change the water when it becomes cool or soiled, and expose only the area being washed.

Oral care: brush teeth at least twice daily and after meals; for an unconscious patient, use a toothbrush or swab with suction, place the patient in a lateral position, and never use a large volume of water.

Pressure areas and skin folds (axillae, groin, under breasts, between toes) must be dried thoroughly after bathing; moisture is a Braden subscale and a risk factor for skin breakdown.

Nutrition basics: a balanced diet supplies carbohydrates, proteins, fats, vitamins, minerals, and water; protein needs rise in wound healing and recovery (roughly 1.0–1.5 g/kg/day depending on condition).

Therapeutic diets: diabetic (controlled carbohydrate, high fibre), low-sodium (<2 g sodium/day for hypertension), renal (restricted protein, potassium, phosphate), and clear-liquid/full-liquid/soft diets for stepwise progression.

Safe feeding: position the patient upright (at least 30–45°, ideally 90°), feed slowly, offer small mouthfuls, check for pocketing of food, and keep the patient upright for 30 minutes after the meal to reduce aspiration risk.

Signs of dysphagia: coughing or choking during eating, wet or gurgly voice, drooling, food pocketing, and regurgitation; report these and stop feeding until assessed.

Elimination support: normal adult bowel frequency ranges from three times a day to three times a week; record stool colour, consistency (Bristol Stool Scale), and any blood or mucus.

Constipation care: encourage fluids, fibre, and mobility; a bedpan or commode should be provided promptly, with privacy, and perineal hygiene performed front to back.

Adult BLS sequence: check responsiveness and breathing (no more than 10 seconds), call for help and activate emergency services, start chest compressions at the centre of the chest, 100–120/min, depth 5–6 cm, full recoil, ratio 30 compressions to 2 breaths.

Use an AED as soon as it is available: power on, attach pads to the bare chest, clear everyone before the shock, and resume compressions immediately after the shock or if no shock is advised.

Choking: for a conscious adult, give up to 5 back blows between the shoulder blades, then up to 5 abdominal thrusts (Heimlich manoeuvre), alternating; for an infant, use back blows and chest thrusts, never abdominal thrusts.

Recovery position: for an unresponsive but breathing patient with no suspected spinal injury - lateral side-lying, lower arm forward, upper leg bent, head tilted back to keep the airway open.

Severe bleeding: apply direct pressure with a clean cloth or dressing, elevate the limb if no fracture is suspected, and add layers rather than removing soaked dressings; use a tourniquet only for uncontrolled limb bleeding.

Burns: cool with running water for at least 20 minutes, remove jewellery and loose clothing, cover with a clean non-adherent dressing; never apply ice, toothpaste, or oil, and never burst blisters.

Fracture and suspected spinal injury: immobilise in the position found, do not attempt to straighten a limb, and do not move the patient unless there is immediate danger.

Anaphylaxis: recognise swelling of the face/throat, wheeze, widespread hives, and falling blood pressure; help the patient use their adrenaline auto-injector (outer thigh) and call emergency services immediately.

Therapeutic communication techniques: active listening, open-ended questions, reflecting, clarifying, and summarising; avoid false reassurance, giving advice, and changing the subject.

Effective handover uses SBAR: Situation, Background, Assessment, Recommendation - concise, structured, and closed-loop confirmed.

Patient rights under the Charter of Patients' Rights (India, 2019) include information, records, informed consent, confidentiality, second opinion, and a grievance redressal mechanism.

Informed consent requires capacity, adequate information (nature, benefits, risks, alternatives), and voluntariness; a GDA may witness consent but cannot obtain it.

Confidentiality: patient information is shared only on a need-to-know basis; do not discuss patients in corridors, lifts, or on social media.

Professional boundaries: accept gifts only per facility policy, never enter into personal or financial relationships with patients, and never share personal phone numbers.

Barriers to communication include language, hearing or vision impairment, anxiety, pain, and cultural differences; use an interpreter, plain language, pictures, and written material as needed.

Aggressive or agitated patients: maintain a safe distance, keep your voice calm and low, avoid arguing, offer choices, and call for help rather than restraining the patient alone.

The GDA is protected under the Employees' Compensation Act and ESI Act for work-related injury and occupational disease; the facility must maintain an accident register.

Needle-stick and body-fluid exposure must be reported immediately and documented in the exposure register; post-exposure prophylaxis is time-sensitive, ideally within 2 hours.

Ergonomic injury prevention: use mechanical lifts or slide sheets for heavy patients, keep the bed at hip height, avoid twisting while lifting, and work in pairs when possible.

Fire safety: know the RACE sequence - Rescue, Alarm, Contain (close doors), Extinguish/Evacuate; use the PASS technique for a fire extinguisher (Pull, Aim, Squeeze, Sweep).

Hazardous material: read the Safety Data Sheet (SDS), use the correct PPE, and follow the spill kit procedure; mercury spills require special handling and must never be vacuumed.

Legal duties: duty of care, confidentiality, accurate documentation, and informed consent; negligence requires a duty, a breach, causation, and damage.

Documentation rules: record contemporaneously, in black ink, sign and date each entry, never erase or overwrite, and correct errors with a single line and initials.

Ethical principles: autonomy (respect patient choice), beneficence (do good), non-maleficence (do no harm), justice (fair treatment), and veracity (truthfulness).

Hand hygiene before and after every patient contact, and before any aseptic procedure, is the single most important step in any skill demonstration.

Vital-sign demonstration is scored on: correct equipment, patient identification, correct site and technique, timing, recording, and reporting abnormal values.

Bed-making: gather linen, perform hand hygiene, remove soiled linen without shaking it, place clean linen without touching the floor, and never hold linen against your uniform.

Sterile technique: open a sterile pack without touching the inner surface, keep the field above waist level, never turn your back on it, and consider it contaminated if it becomes wet.

Specimen collection: label the container at the bedside after confirming patient identity, collect the correct volume, and send it to the laboratory promptly with the correct requisition.

Urinary catheter care: perform perineal hygiene daily, keep the drainage bag below bladder level, avoid kinks, and report cloudy or foul-smelling urine.

Wound dressing: use a clean-to-dirty sequence, remove the old dressing with gloved hands, clean from the centre outward, and dispose of waste in the correct colour-coded bin.

Clinical demonstration scoring typically includes preparation, patient identification and consent, technique, infection control, documentation, and communication with the patient.

The GDA is protected under the Employees' Compensation Act and ESI Act for work-related injury and occupational disease; the facility must maintain an accident register.

Needle-stick and body-fluid exposure must be reported immediately and documented in the exposure register; post-exposure prophylaxis is time-sensitive, ideally within 2 hours.

Ergonomic injury prevention: use mechanical lifts or slide sheets for heavy patients, keep the bed at hip height, avoid twisting while lifting, and work in pairs when possible.

Fire safety: know the RACE sequence - Rescue, Alarm, Contain (close doors), Extinguish/Evacuate; use the PASS technique for a fire extinguisher (Pull, Aim, Squeeze, Sweep).

Hazardous material: read the Safety Data Sheet (SDS), use the correct PPE, and follow the spill kit procedure; mercury spills require special handling and must never be vacuumed.

Legal duties: duty of care, confidentiality, accurate documentation, and informed consent; negligence requires a duty, a breach, causation, and damage.

Documentation rules: record contemporaneously, in black ink, sign and date each entry, never erase or overwrite, and correct errors with a single line and initials.

Ethical principles: autonomy (respect patient choice), beneficence (do good), non-maleficence (do no harm), justice (fair treatment), and veracity (truthfulness).