Advanced Diploma in Critical Care Nursing

Purpose

The purpose of the qualification is to prepare, at professional Advanced Diploma level, a person eligible for registration with the South African Nursing Council (SANC) as a professional nurse with an additional qualification in Critical Care Nursing. Students credited with this qualification will have acquired service orientated, advanced intellectual and clinical competencies in critical care nursing. They will be able to function as independent clinical practitioners, leaders, consultants and specialist practitioners in providing evidence-based care to critically ill patients, together with other team members in the critical care unit, as determined by the appropriate legislative framework.

The qualification will provide a basis for decision-making regarding what is within and beyond the defined scope of practice, as well as an understanding of the referral system in place for anything outside of the scope of practice. Recipients of this qualification will also be able to deal with specified emergencies beyond their scope in case of need. The qualifying student will apply evidence-based nursing practice, which is based on research, or established practices that have proven to be effective within the profession, both nationally and internationally.

The qualification will produce nursing graduates who will be professionally equipped at both nationally and internationally recognised standards to serve the South African community and to function independently in the critical care environment as specialist health care practitioners in hospital based practice.

More specifically, the qualification aims to

• Produce high quality professionals who are able to be competent nursing practitioners in a critical care environment.
• Provide students with a range of skills, knowledge and attitudes that will enable them to make a meaningful and sustained contribution to health services.
• Equip students with a developed sense of equity, justice and service ethics that will ensure accountability, irrespective of their chosen work place.
• Offer a wide range of transferable skills for application in other professions, disciplines and general life. These include:

> A methodical, solution-based approach to problem solving.

> An empowerment strengths-based approach to personal development.

> Competence in written and oral communication.

> An ability to plan, implement and manage projects of a varied nature.

> An ability to work independently and as part of a team.

> An ability to demonstrate knowledge, skills and applied competence in the field of study that provide opportunities for continued personal growth, gainful economic activity and rewarding contributions to society.

As such, the qualification will also be valuable for those in the profession who may have been practicing within the field, but are not able to be formally recognised for registration purposes.

Rationale

A specialist is essential in this field because

• There is limited exposure of pre-registration nurses to critical care nursing.
• The ongoing complexity of technology and the high acuity level of the patients being cared for demand in-depth knowledge and a specialist level of skills and competencies.
• High levels of cardiovascular disease and trauma in the country lead to complex demands on nurses.
• Critically ill patients require specialised nursing care while they are acutely ill. This requires a nurse who is familiar with the principles of management for critically ill patients.

This qualification will address the grave shortage of specialist nurses who are competent to nurse this highly compromised group of patients.

Students who register for this qualification are required to meet the following criteria

• Current registration with the South African Nursing Council (SANC) as a Registered Nurse, which registration is maintained for the duration of the study period.
• Ability to comprehensively communicate what has been learnt in the medium of instruction.
• Ability to learn and take responsibility for own progress.
• Competence in end-user computing at a level to support understanding of technology-based practices prevalent in the specialist area of practice.
• Proficiency in reading, speaking and writing in the English language medium, as this is the language and medium in which all learning material is available.

Recognition of Prior Learning

This qualification can be achieved in part, through recognition of prior learning. Evidence may be presented in a variety of forms, including previous international or local qualifications, reports, testimonials, mentoring, portfolios, work records and performance appraisals. Recognition will be granted in accordance with the specific institutional requirements, in agreement with the relevant Quality Council (QC) and the SANC.

The qualification recognises formal and non-formal prior learning (incorporating experiential learning) in nursing or a functional equivalent at the required NQF Level.

Access to the Qualification

Access is open to registered nurses, conditional to the learning assumed to be in place and student access to an accredited facility that will enable clinical practice to take place under recognised supervision.

In terms of current relevant legislation

• Students are required to be currently registered with the SANC as registered nurses for the duration of the period of learning.
• Students must have access to clinical facilities of health service providers that are accredited by the SANC in agreement with the relevant QC for the practical component.
• Clinical and work-based experiences must comply with the current regulations of the SANC.

All modules are at NQF Level 7 and are compulsory.

Modules

• Internal medicine and surgery, 15 Credits.
• Ethos and Professional Practice, 4 Credits.
• Nursing Unit Management, 14 Credits.
• Introduction to research, 11 Credits.
• Critical Care Nursing, 98 Credits.

Total Credits: 142.

1. Maintain the ethical and moral codes of the nursing profession whilst practicing within the regulations and legislation relevant to a registered nurse in a critical care environment.
2. Practice effectively as both a member and a leader of the critical care health team.
3. Manage a critical care nursing unit based on an in-depth understanding of the specific contextual variables.
4. Apply specialist, evidence based knowledge and skills in the care of critically ill and high risk medical and surgical adult patients.
5. Assess, plan, implement, manage and evaluate critical care services at regional, provincial and national levels within the context of organisational policy and facilitate policy change.
6. Act as a consultant regarding aspects of critical care nursing.
7. Provide appropriate and expert education to individuals, groups and fellow health care professionals.

Critical Cross-Field Outcomes

• Identifying and solving problems using critical and creative thinking within the critical care environment is demonstrated in the application of advanced knowledge of anatomy, physiology, microbiology, pharmacology and nursing science in the provision of adult patient care in the critical care environment and using critical thinking in the assessment, planning, implementation and evaluation of critically ill adult patients and their individualised needs.
• Working effectively with others to develop collaboration within the multidisciplinary team, in the treatment of the critically ill adult patient is demonstrated by maintaining professionalism in communication strategies and demonstrating understanding of diversity and cultural sensitivity in the interaction with people within the critical care environment.
• Organising and managing oneself and one's activities responsibly and effectively to ensure optimum care and treatment in a critical care environment is demonstrated by using correct management of self and time to ensure sound implementation of critical care nursing.
• Collecting, analysing, organising and critically evaluating information related to the critically ill, legislation, structures and processes that impact adult critical care is demonstrated in the application of available information in the management and maintenance of a therapeutic critical care environment.
• Communicating effectively using visual, mathematical and/or language skills in the modes of oral and/or written presentation to collaborate within the multidisciplinary team and to impact on patient care is demonstrated in the application of total acceptance of diversity in all interactions with personnel and patients within the critical care environment.
• Using science and technology effectively and critically, showing responsibility towards the environment and towards the health of others in order to work effectively in the critical care unit is demonstrated in the use of technology in a responsible way in the critical care unit.
• Demonstrating an understanding of the world as a set of related systems by recognising that problem-solving in the critical care unit context does not exist in isolation but is interlinked with collaborative care within the health context is evidenced in the participation of the provision to the needs of adult patients and personnel in all areas of the critical care environment and working in harmony with the multidisciplinary team members.

Associated Assessment Criteria for Exit Level Outcome 1

1.1 Patient rights are upheld through effective advocacy.

1.2 Articulated values and beliefs are congruent with the accepted norms and values pertaining to the critical care environment.

1.3 An adequate knowledge and understanding of legislation and regulations relevant to specialised nursing practice is demonstrated through verbal and written means.

Associated Assessment Criteria for Exit Level Outcome 2

2.1 Policies and protocols in the critical care unit are applied effectively and appropriately.

2.2 Complex ethical issues in critical care are analysed with a view to developing a balanced personal perspective.

Associated Assessment Criteria for Exit Level Outcome 3

3.1 Management approaches and procedures facilitate the establishment of an environment that is conducive to the achievement of quality patient outcomes.

3.2 Management of personnel is effective.

Associated Assessment Criteria for Exit Level Outcome 4

4.1 Assessments of critically ill and high-risk adult medical and surgical patients are conducted accurately.

4.2 Critically ill and/or high-risk adults are managed competently to establish and maintain homeostasis.

4.3 Competent case management of patients referred for critical care is evident.

4.4 The critical care physical environment is managed to optimise patient safety.

4.5 The critical care environment is managed to prevent sensory deprivation and/or overload.

4.6 Emotional disturbance in the critically ill and/or high-risk patient is managed effectively.

Associated Assessment Criteria for Exit Level Outcome 5

5.1 Limitations in legal, ethical and policy guidelines are timeously identified.

5.2 The population morbidity and mortality profiles for critical care at regional, provincial and national levels are accurately analysed and interpreted to establish a population-based diagnosis.

5.3 Critical care health services at regional, provincial and national levels are evaluated and influencing factors are analysed, to identify alternative strategies.

5.4 Regional, provincial and national critical care services are planned and implemented based on evidence-based assessment, in collaboration with appropriate teams.

Associated Assessment Criteria for Exit Level Outcome 6

6.1 Consultancy, referral and clinical supervision are provided to colleagues through client, consultee and service-centred consultation.

Associated Assessment Criteria for Exit Level Outcome 7

7.1 Continuing education is maintained through appropriate identification and utilisation of available learning opportunities.

7.2 Appropriate education for patients and families is provided through both structured and unstructured teaching methods.

Integrated Assessment

Assessment and evaluation during the programme takes place through a process of continuous evaluation, based on a comprehensive and integrated approach. The criteria for assessing students are based on the Exit Level Outcomes listed above and the strategies that will be used to ensure that all the outcomes are achieved. Integrated Assessment comprises formative and summative assessment.

Formative assessment may be made by means of, but not limited to

• Case presentations.
• Portfolios of evidence.
• Workbooks.
• Tests.
• Oral presentations by individuals and project teams.
• Clinical assessment.

Summative assessment may be made by means of, but not limited to

• Written examinations.
• A research report.
• Clinical examination.