Postgraduate Diploma in Adult Critical Care Nursing

Purpose

The Postgraduate Diploma in Adult Critical Care Nursing will serve to strengthen and deepen learner's knowledge in nursing, specifically Adult Critical Care Nursing. The primary purpose of the qualification is to enable working professional nurses to undertake advanced reflection and development through a systematic survey of current thinking, practice, and research methods in Adult Critical Care Nursing. With this qualification, graduates will be able to register as Critical Care Nursing Specialists with the South African Nursing Council (SANC).

The qualification will develop and empower professional nurses with knowledge and expertise in adult critical care practice. Learners will demonstrate advanced competencies and skills developed through critical thinking, clinical practice and research in Adult Critical Care Nursing and can function as part of a team or independently as leaders, consultants, educators, and specialist practitioners in providing evidence-based care. These competencies include accountability and responsibility in professional, ethical, and legal practice; health promotion and prevention of disease, injury, and complications; effective communication and development of therapeutic relationships; quality improvement; and continuous professional development and research. The qualification further aims to provide innovative and distinguished learners with a developed sense of equity, justice, and service ethics that work to make a meaningful and sustained contribution to specialised health services in South Africa. The Adult Critical Care Nurse specialist will be able to demonstrate foundational and conditional knowledge of inter-professional people-centred critical care of adults in a variety of settings.

Upon completion of the qualification, 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

Limited resources were allocated to the Critical Care environment due to a redirection of resources to primary health care to benefit the majority of South Africa's population, (De Beer, Brysiewicz and Bhengu, 2011). Nursing managers of large Critical Care Units (CCUs) in South Africa cited the shortage of competent and trained Adult Critical Care nurses as the biggest challenge in their units (Matlakala and Botha, 2016). The profile of patients admitted to CCUs in South Africa includes mostly trauma admissions (53%), medical (30%), infectious diseases (8%), Gynaecological (5%) and post-surgical (4%) patients. The impact of HIV-infected people puts additional strain on the limited resources in critical care. Out of the world's 40 million HIV-infected people, 5 million are in South Africa (De Beer et al. (2011). There is a total of 4 168 critical care beds in South Africa and 23% of these commissioned beds are not utilised owing to staff and equipment shortages. This shortage of CCU beds is compounded by the limited number of nurses available to work in the units. Most registered nurses provide care in CCUs, and only 25% of nurses in CCUs are qualified CCU nurses (De Beer et al., 2011). Critical Care services need critical care nurse specialists to be effective and to implement the National Health Insurance Plan (NHIP). The qualification will provide the education and training of these adult critical care nurse specialists.

According to the competencies for critical care nurse specialists, and specifically the nature of the specialisation, the critical care nurse specialist is a Professional Nurse with an additional qualification and is registered by the SANC. Adult Critical Care Nursing is the care of patients with life-threatening illnesses and injuries, and it occurs within a continuum from the scene of the initial incident or onset of critical illness such as home through stabilisation, transfer/transportation, emergency, and intensive care up to and including transfer to care in lower acuity levels/ step down units. Adult Critical Care is complex care offered either with or without technology by highly skilled clinical practitioners who may be nursing, medical and or paramedical personnel. Nursing personnel is supposed to be assigned on a 1:1 basis with a running or Floor Nurse who is often a team leader (SANC, 2014)".

The qualification was developed to comply with the new competency framework, competencies and exit level outcomes published by the SANC and to fit into the profile of the NHIP and Regulation 635 of the Nursing Act, 2005 (Act No 33 of 2005) relating to the approval of and the minimum requirements for the education and training of a learner leading to registration as a nurse specialist or midwife specialist as outlined in the government gazette on 5 June 2020, includes the Nursing postgraduate qualification in Adult Critical Care.

Registered nurses working without further training in critical care or intensive care units in South Africa are not fully equipped with the theoretical knowledge or the practical skills to effectively care for critically ill patients. The undergraduate curriculum includes only an introduction to the theory and skills needed to work in specialised nursing environments, and a limited time is spent in specialised units during work-integrated learning (WIL) placements. Registered nurses who work in the adult critical care environment and who wish to improve the quality of patient care of critically ill patients will need additional qualifications to become adult critical care nurse specialists.

Critical Care Units in South Africa range in size, but staff shortages are commonly found in all units. Staff without additional qualifications in critical care are numerous, but only a limited number of personnel can be released to attend further training. Clinical skills training also requires intensive instruction and practice and allocation or rotation to areas where relevant learning opportunities are available. The qualification will therefore be presented to small numbers of learners at a time, depending on the Nursing Education Institution's (NEI's) capacity, as well as the capacity of clinical learning sites from which these learners will be recruited and do their WIL. Registered nurses who complete the qualification will be able to articulate to a master's degree in nursing science.

Professional registration, membership or licensing as required by recognised professional bodies, and proof of collaboration with the relevant stakeholders are linked to three learning pathways. They include general, vocational, and professional. The general pathway links to further education, the vocational pathway will lead to occupations in the workplace and sectors, while the professional pathway will lead to further education at master's degree and career opportunities such as adult critical nursing specialist and registration with SANC.

Typical occupations/professions in which the qualifying learner will operate include a specialist nurse.

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. The following RPL processes may be applied.

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 Nursing Science, NQF Level 7.

And

• Registered professional nurse with the South African Nursing Council (SANC).

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

Compulsory modules, Level 8, 120 Credits

• Applied professional practice and development, 10 Credits.
• Applied evidence-based practice and knowledge translation, 12 Credits.
• Applied quality project management, 8 Credits
• Adult Critical Care Nursing Science 1, 16 Credits.
• Critical Care Nursing Science 2, 16 credits.
• Critical and Clinical Practice, 58 Credits.

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

Associated Assessment Criteria for Exit Level Outcome 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 Outcome 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 the monitoring.

Associated Assessment Criteria for Exit Level Outcome 3

• 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 Outcome 4

• 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 Outcome 5

• 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 Outcome 6

• 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 Outcome 7

• Interpret qualitative and quantitative data related to adult critical care nursing clinical research.
• Communicate the 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 Outcome 8

• 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 Outcome 9

• 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 Outcome 10

• 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 Outcome 11

• 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 individualized 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.
• Evaluate diagnostic and treatment procedures according to treatment guidelines and patient care plans for adult critical care patients.

Associated Assessment Criteria for Exit Level Outcome 12

• Manage laboratory, diagnostic and treatment patient procedures according to care plans, treatment guidelines and patient needs in adult critical care units.
• 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.

INTEGRATED ASSESSMENT

Learner Academic Access, Retention, Attainment and Success (ARAS) require heightened responsiveness in provisions for social justice and equal opportunity, inclusive of but not limited to admission requirements, academic content, assessment approaches and methods, modes of provision, learner academic development and support opportunities, and non-academic support to learners. Teaching, learning and assessment should promote competency-based pedagogical practices that emphasise the promotion of flexible learning and thinking, self-directed and lifelong learning, local and global knowledge, diverse learning opportunities and assessment criteria to promote academic success.

Curriculum compilation implies a logical coherence and continuous constructive alignment of

• the purpose.
• the outcomes and associated assessment criteria.
• the chosen learning components (core, fundamental and elective modules) of the curriculum.
• the learning outcomes and selected content of each module.
• effective teaching, learning and assessment strategies.
• appropriate teaching and learning activities.
• available and appropriate teaching and learning resources to support learner attainment.

Formative and summative assessment

Methods used for integrated assessment include continuous, formative (informal and formal), as well as a summative assessment. Opportunities for both continuous formative and summative assessments are embedded in the learning design of the qualification throughout the years of study, in the form of written and practical assignments, portfolios and practical assessments and written and practical examinations to align with the associated outcomes and assessment criteria and the graduate attributes. The assessment focuses particularly on a critical, creative, and interpretative perspective of the various disciplines. At least one opportunity for integrated assessment, where the main purpose and outcomes of the qualification are assessed, is included in the assessment activities for this qualification.

An inclusive and integrated approach to assessment is incorporated into the qualification; assessment practices will be open, transparent, fair, valid, and reliable to ensure that learners are not disadvantaged during the assessment process. Learners are assessed on the application of learned skills to ensure that theory evolves into effective practice. Several outcomes of related specializations across the different year levels are assessed in an integrated and continuous manner. Examples of methods by which informal and formal formative assessments are done include class and online tests, discussions, feedback and critique during contact and blended learning sessions and practical sessions.

Examples of methods by which continuous assessment is done include

• Portfolios.
• Simulations.
• Self-and group reflections.
• Written assignments.
• Written tests and online tests.
• Case studies and case presentations.
• Peer group evaluation.
• Face-to-face contact with learners.

Summative assessment involves written exam papers, projects, and portfolios of evidence during which all theoretical knowledge, problem-solving skills and practical skills are integrated and assessed. Integrated assessment, including practical portfolios, case studies, and objective structured clinical examination (OSCE) in clinical practice will be used to determine the competence of the nurse specialist. WIL hours will be monitored, and records will be kept as all qualification requirements, including a compulsory practicum.

Ratio of assessment in integrated assessment

The module mark for all coursework modules is based on a combination of a module participation mark and an examination mark in the ratio determined in the applicable faculty rules, except where the module mark is based on continuous assessment or where no participation mark is required. In the case of continuous assessment modules, the module mark is based on the weighted average of the assessments prescribed for the module, according to the weights prescribed for the different assessment tasks.

Experiential Learning (WIL)

Experiential learning (WIL) is purposeful, organised, supervised, and assessed educational activities and experiences that integrate theoretical learning with its application in a real or simulated workplace context. Experiential learning (WIL) forms a compulsory component of the qualification as required/suggested by SANC. Experiential learning (WIL) has as its aim to enhance.

" the excellence and practicability of the learner learning experience,

" the civic responsibility of learners, and

" the vocational skills and, thereby, the workplace readiness and employability of graduates.

The experiential learning module provides the learners with the opportunity to apply their knowledge and skills to the practical learning situation in a real-world context. It is integrated into selected modules designated for such a purpose and must be credit-bearing, supervised and assessed. This is also a system requirement to ensure compatibility and alignment with the Work Integrated Service Learning (WISL) system during the integration of experiential learning (WIL) activities on the system. Faculties must utilise the centralised WISL system to manage their learner placements. Although the system is managed through a central office located in the CTL, experiential learning (WIL) modules and the concomitant activities required to register learners and placement data in the WISL remain with Faculties.