Bachelor of Nursing Honours

Purpose

Rationale

There is rarely any exposure of pre-registration nurses to the complex and dynamic context of specialised nursing practice. The changing context of health care practice with growth in debilitating health conditions demands a cadre of clinical nurse specialists who can provide nursing care to patients in need of specialised nursing care.

The ongoing complexity of technology and the increasing acuity levels of the patients cared for demand specific capacities. Among these is the capacity to self-evaluate, to exercise personal responsibility and initiative and indicate a depth of knowledge. It also demands a high level of skill and competence in specialised health care units.

High levels of trauma and critical illness in the country lead to complex demands on nurses to utilise rapid meta-cognitive problem-solving skills in the resolution of concrete and abstract critical issues.

Furthermore, 80% of midwives deliver midwifery and neonatal services in the country and view of the high perinatal and maternal mortality and morbidity rates; it is essential to have a practitioner able to build the knowledge base and improve practice in midwifery and neonatal nursing. Specialist nurse practitioners will frequently function independently within their scope of practice.

Learners credited with this qualification will be able to function with intellectual and practical competencies in specialised nursing settings as leaders, consultants, educators and specialist practitioners in providing evidence-based care with other team members. Qualifying learners will work as clinical nurse specialists in the health sector. Also, they can set up a private practice and therefore contribute to job creation and employment opportunities in the health sector.

Recognition of Prior Learning (RPL)

Admissions will be guided by the university's RPL Policy which states that prospective learners who have attained a level of competence considered adequate by the university's Senate. Therefore, in line with this policy, the Discipline of Nursing will assess the level of competence of prospective applicants through its internal structures before seeking the approval of the College Academic Affairs Board and the Senate for each applicant. Each applicant will be required to submit a portfolio of evidence for consideration. Learners may apply through the University College of Health Sciences for credit-bearing.

Entry Requirements

The minimum entry requirement for this qualification is

• Bachelor of Nursing Science, NQF Level 7.

Or

• Advanced Diploma: Critical Care Nursing, NQF Level 7.

And

• A minimum of one-year working experience as a nurse.
• Registration with the appropriate nursing regulatory body.

This qualification consists of the following compulsory and elective modules at NQF Level 8 totalling 128 Credits

Compulsory Modules at Level 8.

Elective Modules at Level 8.

1. Function effectively as a clinical nurse specialist with other members of the health within the health care system.
2. Analyse a range of research methods and approaches concerning their appropriateness for investigating particular research problems in specialised nursing and midwifery.
3. Manage and evaluate specialised nursing services for individuals, families and communities at district, the provincial and national level within the context of national health policy and international guidelines in a variety of settings.
4. Demonstrate a practice-based understanding and knowledge of biomedical technologies and nursing skills utilised in support of the care of the critically ill person.
5. Apply evidence-based knowledge and skills to understanding, interpreting and mediating the physical and emotional environment of the critical care unit for patients, their families and staff.
6. Demonstrate a coherent understanding of principles, theories, emerging issues nationally and globally in critical care nursing.
7. Interpret and apply information and data correctly to assess the critically ill adult.
8. Apply specialist knowledge and skills in the care and physiological support of critically ill and high-risk adults and their families.

Associated Assessment Criteria for Exit Level Outcome 1

• Identify and address specialised health information needs through structured and unstructured health education.
• Design and present formal and in-service education programmes for a specific category of clinical nurse specialists and other team members to ensure best practice in specialised nursing and health services.
• Design, implement and evaluate programmes for personal and professional growth in collaboration with colleagues and other members of the specialised health care team.
• Provide community development programmes and projects through advisory and facilitative processes.
• Provide consultancy and referral to colleagues through a client, consultee and service-centred process.

Associated Assessment Criteria for Exit Level Outcome 2

• Ensure the analysis of research approaches and methods is comprehensive and coherent and including theoretical and or philosophical orientations about knowledge, reality and truth as well as the implications of these theoretical orientations for selection of techniques and strategies based on particular research problem(s) and questions.
• Analyse and interpret research reports (quantitative and qualitative) evidence.
• Demonstrate a comprehensive and systematic understanding of data collection techniques.
• Ensure the data analysis procedures and principles and the current professional and clinical discourse in a specific area of nursing and midwifery specialisation.

Associated Assessment Criteria for Exit Level Outcome 3

• Evaluate and manage specialised health care units, programmes and services at the district, provincial and national levels efficiently and effectively.
• Provide mentorship to others in the specialised health team by documented short and longer-term relationships and role modelling.
• Ensure team members receive development and support to cope with the emotional demand of the speciality.
• Maintain professional excellence and competence through continuing education and lifelong learning.
• Identify limitations in ethical, legal, and policy guidelines timeously with particular reference to a human rights approach to transforming legislation and civil structures through lobbying and advocacy.
• Empower patients, families and communities to access existing appropriate resources.
• Determine and interpret the specialised disease profile at district, provincial and national levels and in different settings correctly in the formulation of specialised nursing needs of these communities and regions.
• Ensure quality assurance activities enhance quality in specialised health services.
• Develop and maintain information systems at an aggregate level.

Associated Assessment Criteria for Exit Level Outcome 4

• Maintain principles of ventilation in the application of various modes of ventilation.
• Demonstrate technologically assisted assessment and support of the various organ systems in critically ill patients (adults and children) accurately, including:

> Advanced monitoring techniques for all body systems.

> Evaluation of laboratory tests.

> Microbiological surveillance.

> Evaluation of diagnostic tests, including the ECG and CXR.

> Evaluation of pain.

• Demonstrate skill and knowledge in Advanced Life Support and resuscitation techniques of both adult and child.
• Apply principles of renal replacement therapies in the provision of nursing care to individuals with severe and life-threatening renal health problems.
• Demonstrate an understanding of the causes and pathophysiology of shock.

Associated Assessment Criteria for Exit Level Outcome 5

• Manage and prevent the risks of the technological environment effectively to ensure a safe environment (e.g. correct use of equipment, noise management, sensory overload and deprivation etc.).
• Promote the implementation of infection control measures to enhance the safety of the critical care environment.
• Anticipate, identify and manage the psychosocial, cultural and emotional needs of the critically ill patient and their family, (including patient rights and advocacy).
• Demonstrate an ability to contribute to a cohesive multidisciplinary critical care team.
• Develop knowledge and skills for effective management of death, dying, and complex ethical issues, (e.g. withdrawal of therapy), within a high-stress environment.
• Understand the importance of effective coaching, support and mentorship of the critical care team.

Associated Assessment Criteria for Exit Level Outcome 6

• Integrate theoretical frameworks that underpin critical care nursing practice into clinical practice.
• Articulate points of view regarding emerging national and global issues and policies demonstrate an in-depth and critical understanding of relevant discourses in critical care nurses.
• Ensure the contributions on complex and controversial debates on critical care nursing issues reflect an appreciation of the dynamic and tentative nature of most human knowledge.

Associated Assessment Criteria for Exit Level Outcome 7

• Understand advanced knowledge of anatomy and physiology of the adult, including metabolic and biochemical processes of all body systems id displayed.
• Conduct an assessment of the critically ill and high-risk patient in an integrated manner and includes measures of physical, psychosocial emotional and spiritual needs.
• Utilise specialist nurse competencies effectively and correctly in the assessment of the functioning of specific body systems in critically ill patients:

> Cardiovascular System, including haemodynamic and cardiac monitoring.

> Respiratory System, including arterial blood gas analysis.

> Neurological System, including invasive intracranial pressure monitoring.

> Renal System, including acid-base balance.

> Metabolic/Endocrine System, including glycaemic control, sleep/rest cycles.

> Gastro-intestinal System, including nutritional assessment and elimination.

> Integumentary System, including the assessment of wounds.

> Haematological system, including coagulation studies.

> Evaluation of immune system.

> Assessment of pain and anxiety

• Interpret laboratory results and special investigations and procedures with the clinical interface.

Associated Assessment Criteria for Exit Level Outcome 8

• Apply knowledge of the pathophysiological basis for compromise of the various organ systems to the care of critically the ill adult.
• Demonstrate knowledge of the care of the critically ill adult using evidence-based interventions in respect of the following:

> Airway management and respiratory support.

> Cardiac support, including pacemakers and IABP.

> Haemodynamic support.

> Fluid therapy.

> Electrolyte imbalance.

> Acid-base imbalance.

> Nutritional support.

> Endocrine and metabolic derangements.

> Pain management and sedation.

> Thermoregulation.

> Sepsis surveillance.

> Basic hygiene and comfort needs.

• Demonstrate competence in the nursing management of patients who require critical care, (including promotive, preventative and rehabilitative measures) of the following:

> Compromised CVS function e.g. acute coronary syndrome, valvular disease, cardiothoracic surgery, vascular surgery.

> Compromised respiratory function e.g. acute respiratory failure, ventilator dependency, obstructive and restrictive disorders, and adult respiratory distress syndrome.

> Compromised neurological function e.g. head and spinal cord injuries, cerebrovascular accidents, neuromuscular disorders.

> Compromised renal function e.g. acute renal failure.

> Compromised endocrine function e.g. diabetic ketoacidosis.

> Compromised gastro-intestinal and Hepatic function e.g. abdominal trauma, acute pancreatitis, severe GIT haemorrhage, liver failure.

> Compromised haematological function e.g. disseminated intra- vascular coagulopathy.

> Obstetric related illness e.g. HELLP syndrome.

> Compromised Immune system e.g. immunosuppressive therapy, infectious diseases, HIV/AIDS-related illnesses.

> Multisystem Disorders e.g.

> Multiple organ dysfunction syndrome.

> Severe sepsis and related syndromes, including

> Systemic Inflammatory Response Syndrome.

> Polytrauma.

> Physiological shock - all types.

> Acute Intoxications, including

a. Accidental poisoning.

b. Recreational drug abuse.

c. Intentional drug overdose.

> Burns.

• Exhibit a comprehensive knowledge of the pharmacotherapy (including pharmacodynamics and pharmacokinetics) of the various drugs used in the management of the critically ill adult.

Integrated Assessment

Formative

• During the year, there will be assignments, tests, group work, projects and clinical evaluation.
• The evaluation includes both theory and clinical assessments in an integrated manner.
• Case presentations provide the opportunity for formative integrative assessment of knowledge, skills (cognitive and interpersonal) and attitudes including the integration of knowledge and skills from the fundamental or core modules, for example, natural sciences, leadership and management, research and philosophical underpinning of practice.

Summative

• A minimum of three assessments for each 16 Credits module, one of which shall be a clinical assessment.
• Summative assessment in each module includes an assessment of the learner's ability to critique current knowledge from international; the national and local sources, including current practice.
• Also, summative assessments assess the students' ability to use reflective practise and problem-solving skills to plan; implement and evaluate community health interventions aimed at improving health care outcomes.

The research project is a practical, real-life integrated assessment of the student's application and integration of knowledge from this programme.