Postgraduate Diploma in Adult Critical Care Nursing

Purpose

The primary purpose of the Postgraduate Diploma in Adult Critical Care Nursing is to develop, reconstruct and revitalize the profession which enables the Adult Critical Care nurse to undertake advanced development and reflection. This will be achieved through a systematic survey of current thinking, practice, and research methods in the discipline of Adult Critical Care Nursing. This is to ensure adult critical care nurses are equipped to address the disease burden and population health needs within a revitalized health care system in South Africa.

On completion of the qualification, the adult critical care nurse will practice as a competent, independent, critical thinker to provide scientific, safe comprehensive quality nursing care. The aim is to promote healing, prevent complications and alleviate suffering based on acquired knowledge, skills, and competencies.

The needs of the client will be met through a holistic approach by addressing the physical, psychological, and social dimensions of the healthcare user within the public and private healthcare domain.

In addition, the adult critical care nurse will be able to establish a research culture that will lead to evidence-based and reflective practice as well as lead and manage self and others within the multi-disciplinary team. The image of nursing will be upheld through the application of an ethical, legal, and professional framework.

On completion of the qualification, adult critical care nurses will be able to progress in the marketplace with advanced knowledge, skills, and specific competencies. To enhance competencies in a specialization which will improve/advance the quality of nursing care and advance nursing knowledge and skills to address health needs.

Upon successful completion of this qualification, adult critical care nurses are eligible for registration with the relevant statutory body, the South Africa Nursing Council, as an Adult Critical Care Nurse. This qualification provides a career path for Professional Nurses who want to stay in the clinical context, but who would like to specialize.

The Qualification aims to

• Develop an adult critical care nurse who is a competent, independent critical thinker who will provide scientific, safe comprehensive quality nursing care to address the health needs of the public/private patient, families, and communities within the legal-ethical framework of adult critical care nursing.
• Enhance and maintain professionalism and professional ethos amongst members of the nursing and midwifery profession.
• Promote and enhance evidence-based nursing practice and reflective thinking.
• Equip the adult critical care nursing practitioner to address the population's health care needs within the parameters of Health Care Plan 2030, the disease burden, and Millennium Developmental Goals.
• Provide direct access to a master's degree.

Upon Completion the qualifying learner will be able to

• Practice and facilitate adult critical care nursing, nursing education or health services management within the ethical-legal parameters of the profession.
• Apply knowledge of and facilitate evidence-based practice, nursing education or management in the adult critical care nursing field to solve contextual problems and develop policies and guidelines.
• Engage in planning, commissioning, and managing an adult critical care nursing unit, an educational entity, or a health service.
• Utilize, manage, and communicate data to support decision-making and research in adult critical care nursing.
• Develop and implement institutional policies, protocols, and guidelines in adult critical care nursing utilising the process of change management in the improvement of quality of care.

Rationale

Adult critical care nursing is a specialist area of nursing that involves caring for patients suffering from life-threatening illnesses in a highly technological environment. Adult critical care nurses must display in-depth knowledge and competency in nursing care, problem-solving and a high level of decision-making skills.

The rationale behind the qualification is to develop a specialist critical care nurse practitioner in adult critical care nursing with advanced knowledge and expert clinical skills in line with the National and Provincial Healthcare Plans and Sustainable Development Goals as guided by the World Health Organisation (WHO). The aim is to promote the health status of the South African population and alleviate the lack of skilled practitioners to address the quadruple burden of disease in the healthcare system.

The South African Nursing Council endorsed this qualification in Adult Critical Care Nursing to be designated as a specialist nursing qualification.

This qualification aims to increase the number of qualified nurses who can practice within a specialized field in hospitals, clinics, industries and communities in both public and private sectors.

Nursing specializations are a sought skill for nurse practitioners and offer a career path according to the National Scarce Skills list. There is an ever-increasing demand for applicants to complete this Adult Critical Care Nursing qualification. South Africa needs qualified adult critical care nurses both to improve practice and to train other people. According to the Western Cape Persal training needs analyses (Western Cape Department of Health Persal: 15.07.2018), there is a gap of 113 Adult Critical Care nurses that needs to be trained. The projected number to train is thirty Adult Critical Care nurses in 2021 and another 30 in 2022. This indicated that demand exceeds supply at this stage.

The healthcare state of South Africa, including the standing of critical care nursing, was described by de Beer, Brysiewicz and Bhengu (2011). The brain drain has resulted in South Africa facing a critical shortage of intensive/critical care nurses. This situation is multi-factorial - and includes inadequate salaries, limited career opportunities, poor nursing leadership, poor working conditions and a lack of safety and security in the workplace. Due to the shortage of critical care nurses, it has become the norm to employ agency nurses, to manage the demands of workload. Agency staff often displays a lack of commitment, and their work is not up to the standards of quality of patient care (de Beer, Brysiewicz and Bhengu, 2011). This phenomenon leads to medical legal risks.

In the context of challenges facing Adult Critical Care Nursing, there is a great need for adult critical care nurse training in South Africa and it is important that proper planning and more resources be allocated to funding of training of adult critical care nurses. The other challenge is the imbalance between the private sector, which is highly resourced with ICU beds, compared to the public sector which serves the majority of the South African public with health care (De Beer J, et al. 2011).

Recognition of Prior Learning (RPL)

The institution has an approved Recognition of Prior Learning (RPL) policy applicable to equivalent qualifications for admission into the qualification. RPL will be applied to accommodate applicants who qualify. RPL thus provides alternative access and admission to qualifications, as well as advancement within qualifications.

RPL for access

• Learners who do not meet the minimum entrance requirements or the required qualification that is at the same NQF level as the qualification required for admission may be considered for admission through RPL.
• To be considered for admission in the qualification based on RPL, applicants should provide evidence in the form of a portfolio that demonstrates that they have acquired the relevant knowledge, skills, and competencies through formal, non-formal and/or informal learning to cope with the qualification expectations.

RPL for exemption of modules

• Learners may apply for RPL to be exempted from modules that form part of the qualification. For a learner to be exempted from a module, the learner needs to provide sufficient evidence in the form of a portfolio that demonstrates that competency was achieved for the learning outcomes that are equivalent to the learning outcomes of the module.

RPL for credit

• Learners may also apply for RPL for credit for or towards the qualification, in which they must provide evidence in the form of a portfolio that demonstrates prior learning through formal, non-formal and/or informal learning to obtain credits towards the qualification.
• Credit shall be appropriate to the context in which it is awarded and accepted.

Entry Requirements

The minimum entry requirement for this qualification is

• Advanced Diploma in Critical Care Nursing, NQF Level 7

Or

• Advanced Diploma in Trauma and Emergency Nursing, NQF Level 7

Or

• Bachelor of Arts in Health Care Studies, NQF Level 7

And

Postgraduate students are deemed to be a Registered Professional Nurse registered with the SANC.

This qualification consists of the following compulsory modules at National Qualifications Framework Level 8 totalling 120 Credits.

Compulsory modules, Level 8, 120 Credits.

• Nursing Research and Professional Ethics, 12 Credits.
• Leadership and Management in Advanced Nursing Practice, 12 Credits.
• Foundations of Critical Care Nursing, 24 Credits.
• Critical Care Nursing in Medical Conditions, 28 Credits.
• Critical Care Nursing in Surgical Conditions, 28 Credits.
• Unique Patient Population in Critical Care Nursing, 16 Credits.

Exit Level Outcomes

1. Practice and facilitate adult critical care nursing, nursing education or health services management within the ethical-legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice, nursing education or management in the adult critical care nursing field to solve contextual problems and develop policies and guidelines.
3. Engage in planning, commissioning and managing an adult critical care nursing unit, an educational entity, or a health service.
4. Engage in scholarly activities to inform evidence-based practice, education, or management in adult critical care nursing
5. Utilize, manage and communicate data to support decision-making and research in adult critical care nursing.
6. Render and coordinate patient-centred adult critical care nursing practice within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences including advanced pharmacology.
7. Mobilize appropriate resources to implement standards of practice in adult critical care nursing, to ensure quality patient care and safety.
8. Develop and implement institutional policies, protocols, and guidelines in adult critical care nursing utilising the process of change management in the improvement of quality of care.
9. Facilitate advocacy for the profession and provision of specialist professional support for personnel, patients, families, and communities in adult critical care nursing.
10. Appraise and develop self, peers, and adult critical care nurse students by facilitating self-directedness/leadership and lifelong learning to maintain competence
11. Collaborate within the inter-professional team by engaging in health dialogue, shared leadership, decision-making and sound clinical judgment related to adult critical care nursing.
12. Participate in the design, development, implementation and evaluation of adult critical care nursing policies, programmes, and projects at provincial or national level.

Associated Assessment Criteria for Exit Level Outcomes 1.

• Arrange inter-professional support from health care specialists to assist in planning care for the adult critical care patient according to assessed needs and unique conditions.
• Apply ethics and ethical frameworks to guide decision-making in adult critical care nursing practice.
• Debate the importance of ethical and legal framework in adult critical care nursing.
• Apply ethical principles when conducting clinical research in adult critical care nursing.
• Manage moral distress in the multidisciplinary team in the adult critical care nursing unit.
• Empower healthcare workers to manage moral distress in the adult critical care unit.
• Conduct and monitor the continuous professional development of the adult critical care nursing team.
• Provide support in the moral decision-making process to staff, patients, and families in relation to adult critical care nursing.

Associated Assessment Criteria for Exit Level Outcomes 2.

• Perform interdisciplinary ward rounds to audit adult critical care practices.
• Implement appropriate interventions in collaboration with the inter-professional team based on the outcome of assessments conducted in the adult critical care units.
• Evaluate the importance of research and clinical evidence-based guidelines related to adult critical care nursing in implementing evidence-based practice.
• Reflect on the ways that adult critical care nursing research literature can be used as evidence for nursing practice.
• Utilise the research process in evidence-based adult critical care nursing research.
• Provide comprehensive integrated adult critical nursing care for the current burden of diseases presenting to adult critical care units across the different levels of healthcare provision based on monitoring done.

Associated Assessment Criteria for Exit Level Outcomes 3.

• Collect and compile data for the identification of needs and envisaged improvement in service delivery in the adult critical care unit.
• Participate in the entire process of planning, commissioning, and management of an adult critical care unit on all levels including all role-players.
• Reflect on the role of the adult critical care nursing operational manager in submitting the unit`s needs for inclusion in the capital budget.

Associated Assessment Criteria for Exit Level Outcomes 4.

• Apply leadership and management skills in the management of the adult critical care unit based on evidence from audits.
• Explore evidence-based research in adult critical care nursing.
• Conduct a needs analysis of the adult critical nursing staff training needs.
• Develop a proposal to the adult critical care nursing management for training activities to be included in the annual institutional CPD plan.

Associated Assessment Criteria for Exit Level Outcomes 5.

• Interpret qualitative and quantitative data related to adult critical care nursing clinical research and communicate these findings to the interprofessional team to improve the health of adult critically ill patients.
• Explore how research is used as evidence guiding the practice of adult critical care nursing.
• Analyse and interpret the relevant literature pertaining to the content, methodological patterns, differences, similarities, and study limitations in adult critical care nursing research.

Associated Assessment Criteria for Exit Level Outcomes 6.

• Apply knowledge of pathophysiology, biosciences, pharmacology, and social sciences to explain the interpretation of health assessment findings for adult critically ill patients.
• Develop comprehensive individualized family-centred culture-sensitive treatment plans based on assessment findings of the adult critical care patient.
• Compare the methods of pharmacological and non-pharmacological approaches in the management of an adult critically ill patient.
• Apply knowledge of infrastructure and advanced technological equipment in adult critical care nursing.
• Deliver integrated, promotive, preventive, curative, rehabilitative and palliative care in the adult critical care healthcare continuum.
• Manage laboratory and diagnostic investigations according to treatment guidelines and patient needs when nursing adult critically ill patients.

Associated Assessment Criteria for Exit Level Outcomes 7.

• Conduct condition-specific assessments of adult critically ill patients suffering from cardiovascular conditions, respiratory system medical conditions, neurological conditions, endocrine conditions, renal medical conditions, and gastro-intestinal medical conditions.
• Conduct condition-specific assessments of adult critically ill patients suffering after surgery interventions e.g., abdominal surgery, cardiothoracic surgery, endocrine surgery, neurosurgery, orthopaedic surgery, pulmonary surgery, peripheral vascular surgery.
• Participate in local and national forums to participate in formulating recommendations for improvement in adult critical care nursing.
• Apply advanced life support skills according to adult critically ill patient`s needs in the adult critical care unit or simulation.

Associated Assessment Criteria for Exit Level Outcomes 8.

• Manage laboratory, diagnostic and treatment patient procedures according to care plans, treatment guidelines and patient needs in adult critical care units.
• Perform interdisciplinary ward rounds to audit adult critical care nursing-related practices.
• Apply infection control measures according to updated protocols, policies and guidelines on patients presenting to the adult critical care unit.
• Design guidelines to improve health outcomes of adult critically ill patients within the inter-professional team.
• Record interpreted and plan appropriate actions for each adult critical care patient within an inter-professional team approach.

Associated Assessment Criteria for Exit Level Outcomes 9.

• Provide support to patients and families of significant others during the end-of-life care process in the adult critical unit.
• Communicate the process to support the family about the process of organ and tissue donation with the transplant coordinator in the adult critical care unit.
• Promote continuous professional development of nursing staff in adult critical care nursing to advance competencies and improve the quality of nursing care.
• Advocate for the professional role in adult critical patient care, communication with the community and lobbying for change.
• Plan actions to provide people-centred care considering the client's needs, values, beliefs, preferences, and culture to improve the health status of the adult critically ill patient.

Associated Assessment Criteria for Exit Level Outcomes 10.

• Apply leadership and role modelling theories in delivering patient care to enhance quality in adult critical care nursing.
• Illustrate responsibility for own professional development and nursing team members assigned to the adult critical care nursing team to promote continuous professional development to advance competencies and improve the quality of nursing care.
• Promote and monitor CPD attendance for adult critical care nursing staff.

Associated Assessment Criteria for Exit Level Outcomes 11.

• Participate in planning committee meetings and monitor the adherence to identified needs and standards on all levels related to adult critical care nursing.
• Explore dynamics that may impact the financial management in an adult critical care facility/unit.
• Apply knowledge to defend the advantages of good leadership for effective teamwork within the adult critical care nursing service delivery.
• Explore guidelines to improve health outcomes of adult critically ill patients within the interprofessional team.

Associated Assessment Criteria for Exit Level Outcomes 12.

• Collect and compile data for identification of need and envisaged improvement in adult critical care nursing service delivery nationally.
• Contribute towards the delivery of comprehensive individualised family-centred culture-sensitive treatment plans based on assessment findings including the application and evaluation of relevant policies and programmes related to adult critical care nursing on all levels.
• Judge diagnostic and treatment procedures according to treatment guidelines and patient care plans for adult critical care patients.

INTEGRATED ASSESSMENT

Assessment consists of a continuous assessment system comprising formative and summative assessments.

Formative Assessment

• Assessment task (e.g., a 'quiz', a draft of an essay or report in a writing process, or a 'mock exam').

Summative Assessments

• Assignments
• Case studies
• Tests (written or oral)
• OSCE
• Portfolios
• Workbooks.

Students' progress will be assessed at the end of a section of work rather than exclusively by final assessment at the end of the semester/year.

A minimum of two and a maximum of three assessments will be performed for a semester subject.

For year subjects a minimum of three and a maximum of five assessments will be conducted. Assessments (theory and clinical) will contribute equal weight (percentage) towards the final mark.

Assessments will be conducted in the subjects for both theory and clinical learning (WIL). In the subject templates the assessments are stipulated for both theory and clinical learning (WIL component) as well as the content that will be assessed.

In the core subjects (Nursing Research and Professional Ethics; Practice; Foundations of Critical Care Nursing; Leadership and Management in Advanced Nursing Practice; Critical Care Nursing in medical conditions; Critical Care Nursing in Surgical Conditions; Unique Patient population in Critical Care Nursing), the theory comprised of 40% and Work Integrated Learning (WIL) comprises of 60%. Students must pass both the theory and WIL components to pass the subject.

To pass a subject, the learner must have at least 50% as a final mark. In core subjects, both theory and clinical learning components must be passed to pass the subject.