Postgraduate Diploma in Adult Critical Care Nursing

Purpose

The purpose of this Postgraduate Diploma in Adult Critical Care Nursing qualification is to strengthen and deepen the learner's knowledge and expertise in Adult Critical Care Nursing as a speciality. It will enable critical care nurse specialists to undertake advanced reflection and development by engaging in evidence-based research in their field. Furthermore, this qualification will enable a link between professional practice accountabilities, competence, research, leadership, and quality patient care.

The qualification aims to develop Adult Critical Care nurse specialists who will use expert knowledge and skills to provide intensive monitoring and life support treatments for adult patients with potential or established organ failure, including preventive, promotive, rehabilitative, and palliative management. The Psychosocial support of critical care patients and their families is prioritized across the entire spectrum of care.

This qualification will enable the Adult Critical Care nurse specialist to play a significant role in the care of the critically ill adult patients with life-threatening illnesses or injuries, utilising a holistic, comprehensive management approach in a variety of critical care clinical settings. This qualification will provide extensive theoretical engagement, critical thinking, sound clinical judgement, and a high level of decision making, including the ability to apply specialised knowledge to a range of critical care contexts to render lifesaving and comprehensive evidence-based health care to the adult critical care patient

The curriculum is competency-based and has a strong component of work-integrated learning. The learner will be placed in a variety of critical care discipline-specific intensive care units throughout the qualification, as part of work-integrated learning to facilitate the integration of theory to practice and development of the required competencies in line with the requirements of the relevant statutory professional bodies.

The curriculum content is structured in such a manner that it will equip the learners with the competencies in critical care nursing skills and health technology equipment as well as optimal hands-on learning opportunities in the provision of adult critical care nursing in various healthcare settings to address the intensive care needs of the country within the critical care nurse competencies.

The qualification utilises student-centred approaches in teaching and learning, aimed at providing the specialist nurse with a wide range of skills, knowledge, and attitudes which will promote the culture of lifelong learning and continuing professional development.

Upon completion of this qualification, qualifying learners will be able to

• Participate and facilitates evidence-based practice and research initiatives to improve critical care nursing practice.
• Demonstrate leadership by providing, facilitating, and promoting the best possible care to critically ill patients.
• Utilise resources effectively and efficiently to provide prompt, specialised care to critically ill adult patients in a variety of health care settings.

Rationale

The qualification is aligned to the Higher Education Qualification Sub-Framework (HEQSF), South African Nursing Council (SANC) Postgraduate Diploma in Nursing Qualification Framework, and SANC Competencies for Adult Critical Care Nursing. This qualification will enable the Adult Critical Care Nurse Specialist to function as a leader who is clinically focused, service-oriented, autonomous, innovative, and able to render comprehensive, scientific Adult Critical Care Nursing, as determined by the appropriate legislative framework.

The COVID-19 pandemic highlighted the irreplaceable role of nurses in general and critical care nurses in particular in the intensive management of life-threatening illnesses and placed a huge stress on critical care resources in the country and the KwaZulu-Natal Department of Health in particular. The burden of accidents and trauma-related critical illness further compounds the demand for intensive care. Before the pandemic, related injuries, such as motor vehicle collisions, gunshots, and stabbings, accounted for 65% of intensive care unit (ICU) admissions, while sepsis, metabolic conditions, and overdose resulted in 30% admissions.

In a resource-restricted setting such as South Africa, where HIV is prevalent, HIV associated respiratory impairment results in patients requiring prolonged ICU stay, which compounds the pressure on limited intensive care facilities and resources. The qualification is therefore responding to the above-mentioned health care needs aimed at preparing Adult Critical Care Nurse Specialists with the knowledge, skills, and professional values for advocating, preventing, promoting health, and managing the specialised acute and chronic health care needs of the critically ill adult patient with life-threatening conditions in a variety of critical care clinical settings.

A national audit of critical care resources by the Critical Care Society of South Africa revealed a nurse-to-patient ratio of 1.1: 1, and only 25.6% were ICU trained. This is below international norms of a 1:1 nurse-patient ratio, and a minimum of 50% professional nurses should be ICU trained. According to the Human Resource for Health strategy, South Africa has an 80% nurse-based health system.

Given the central role nurses play in the South African health system, the qualification will address human resources needs and skills gap in line with the current burden of disease. Furthermore, Sustainable Development Goal 3C, which is aimed at improving service quality and addressing the challenges in the health system, will be met (Human Resources for Health Strategy). The qualification will curb the shortage of critical care nurse specialists, as shown in the SANC statistics under the Strategic Plan for Nurse Education, Training and Practice 2012/13 2016/17, which states that there has been a gradual and significant decline in the production of critical care nurse specialists.

The qualification will produce an adult critical care nurse specialist who is competent to function effectively in a highly technological, dynamic health care environment, which requires health care professionals who can promote and provide excellence in the intensive care of adult critical ill patients and their families through a comprehensive, interprofessional, evidence-based approach to critical care nursing practice.

Recognition of Prior Learning (RPL)

Because of the use of legacy access routes, RPL becomes part of the traditional application and admission process.

RPL for access

• The SANC's Education and Training Guideline for Postgraduate Diplomas is specific about the minimum requirements for admission:
• Proof of current registration as a Professional Nurse and Midwife or a General Nurse with a Midwifery qualification. Considering this requirement, it is challenging for a higher education institution to accommodate applicants via the route of RPL for access.

Entry Requirements

The minimum entry requirement for this qualification is

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

Or

• Bachelor of Nursing, NQF Level 7

Or

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

Or

• Bachelor of Nursing Science, NQF Level 7.

And

• Registration with SANC as a Professional Nurse and Midwife.

And

• Registration with the SANC as a General Nurse with a Midwifery.

This qualification consists of the following compulsory modules at National Qualifications Framework 8, totalling 128 Credits:

Compulsory Modules, NQF Level 8, 128 Credits

• Foundations of Critical Care Nursing,16 Credits
• Critical Care Nursing, 24 Credits.
• Critical Care Nursing, 24 Credits.
• Nursing Research, 16 Credits.
• Clinical Nurse Specialist Practice, 16 Credits.
• Contemporary Issues Critical Care Nursing, 8 Credits.
• Critical Care Nursing, 24 Credits.

1. Practice and facilitate critical care nursing within ethical-legal parameters of the profession by applying critical decision-making and moral reasoning in making clinical judgements and solving ethical dilemmas within the critical care nursing practice.
2. Demonstrate current in-depth speciality knowledge, skills, attitudes, and professional values in rendering comprehensive care to adult critically ill patients.
3. Demonstrate understanding of South African and international guidelines in managing adult patients with life-threatening diseases and injuries.
4. Advocate for the compromised critically ill adult patients and participates in ethical practice from acute management to rehabilitation.
5. Participate and facilitate evidence-based practice and research initiatives to improve critical care nursing practice.
6. Demonstrate leadership by providing, facilitating and promoting the best possible care to critically ill patients.
7. Utilise resources effectively and efficiently to provide prompt, specialised care to critically ill adult patients in a variety of health care settings.
8. Participate in the design, development, implementation, and evaluation of nursing policies, programmes, and projects applicable to critical care nursing practice.
9. Utilise the process of change management in the improvement of the quality of 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, programmes, and projects at the provincial or national level.
12. Develop and implement institutional policies, protocols, and guidelines in the adult critical care nursing area of specialization, utilising the process of change management in the improvement of quality of care.

Associated Assessment Criteria for Exit Level Outcome 1

• Illustrate personal attributes and behaviour, demonstrating conformity to the relevant code of ethics in the practice of specialist nursing.
• Apply critical decision-making and moral reasoning models and principles to make clinical judgements and resolve ethical dilemmas within the specialist practice.
• Illustrate accountability for own professional judgement, actions, outcomes of specialist care provided, and continued competence.
• Identify and apply the relevant current legislation, policies, regulations, and guidelines about specialist practice.
• Document all care activities accurately, comprehensively, and promptly, considering the legal requirements for record-keeping.
• Illustrate knowledge of the nurse specialist role in the management of professional misconduct and risks, taking into consideration the institutional protocols and ethical-legal framework.

Associated Assessment Criteria for Exit Level Outcome 2

• Engage in specialist practice, demonstrate understanding of and the process of evidence-based practice.
• Apply evidence-based specialist practice that takes into consideration the appropriate methodology of gathering evidence for practice.
• Apply evidence-based practice, demonstrating knowledge of and critical analysis of the various levels of evidence.

Associated Assessment Criteria for Exit Level Outcome 3

• Illustrate leadership skills through application of appropriate leadership styles, principles, and theories of health services management.
• Facilitate Continuous Professional Development (CPD) for self and others for lifelong learning by creating a positive learning climate in the workplace through the processes of mentorship, preceptorship, supervision, performance appraisal, etc.
• Engage in performance appraisal and demonstrate understanding of the purpose and processes of the performance management and development system.
• Utilise feedback gained from self-reflection, peers, learners, management, and other relevant stakeholders to improve effectiveness in the specialist role.
• Illustrate understanding of the various risk factors that impact health and wellness within the workplace and apply strategies to care for self, peers, employees, and learners.

Associated Assessment Criteria for Exit Level Outcome 4

• Apply understanding of the purpose of the advocacy role for a nurse specialist practice.
• Apply Advocacy principles to ensure safe and quality care in various healthcare settings.
• Illustrate the use of appropriate communication skills and channels in facilitating advocacy.

Associated Assessment Criteria for Exit Level Outcome 5

• Illustrate understanding of levels and classification of the respective specialist units.
• Commission task takes into consideration the burden of diseases and priority services as determined by current events.
• Participate in the evaluation of the existing specialist unit, demonstrating knowledge of guidelines for provisioning a specialist unit
• Engage in planning and commissioning demonstrates understanding of the role and responsibilities in this task within the inter- and intra-professional team.

Associated Assessment Criteria for Exit Level Outcome 6

• Illustrate knowledge of appropriate search engines and databases for review of literature to inform evidence-based practice.
• Apply appropriate methods to generate evidence for utilisation in specialist practice (e.g., research, systematic reviews, etc.)
• Illustrate awareness of peer-reviewed journals and their use for sharing of evidence.
• Utilise activities in specialist practice based on scientifically proven evidence.
• Participate in inter- and intra-professional dialogues, debates, or discourses in quality improvement.

Associated Assessment Criteria for Exit Level Outcome 7

• Document all data gathered in the context of the specialist practice for utilisation and storage in accordance with the set standards.
• Utilise comprehensive data, information, and emerging evidence pertinent to the respective specialist practice.
• Identify and diagnose opportunities for improvement based on gathered and critically analysed assessment data from the patients/clients, families, communities, including current scientific evidence.
• Demonstrates respect for intellectual property and is without plagiarism.

Associated Assessment Criteria for Exit Level Outcome 8

• Illustrate understanding of the position of the critical care nursing specialist service within the health care system.
• Apply the critical care nurse specialist conversant with the full range of services within the specialist area of practice.
• Apply critical care nursing, promotive, preventive, curative, rehabilitative, and palliative care in a healthcare continuum.
• Apply knowledge, skill, and attitudes involved in rendering critical care nursing in accordance with national and international standards and protocols of the critical care nursing specialist field.
• Formulate nursing diagnoses congruent with the patient's or client's clinical manifestations/data, based on accurate analysis and interpretation of data obtained from scientific, laboratory, diagnostic, technological, and psycho-sociocultural assessment, including consultation of relevant or current literature or evidence.
• Individualise, plan nursing interventions considering patients'/clients' needs, values, beliefs, preferences, culture, and contextual variables, for example, disease burden, health risks, national priorities, etc.
• Plan nursing interventions based on formulated nursing diagnoses, and application of critical care specialised knowledge and skills (competencies), including advanced pharmacology in collaboration with the inter- and intra-professional team.
• Implement nursing interventions timeously, accurately, safely and effectively in accordance with set evidence-based standards, guidelines, protocols, algorithms etc. specific for the specialist field.
• Plan health care interventions in collaboration with the patient or client, family and relevant members of the health care team.
• Plan Nursing interventions, including preparation of patients or clients, families, and nurses in the lower-level care for continued care in the hospital and community in accordance with the health status and health literacy of the patient/client.
• Document Nursing interventions timeously and effectively based on critical analysis of the monitoring and evaluation data and reaching a sound clinical judgement

Associated Assessment Criteria for Exit Level Outcome 9

• Illustrate understanding of the infrastructure and equipment needed in the critical care nursing practice area of specialisation.
• Operate and monitor the equipment used in the critical care nursing specialist area.
• Apply sound asset management principles to ensure appropriate, adequate, well-maintained, and up-to-date equipment.
• Assign staff to nursing care, taking into consideration the critical care nursing specialist qualification and its competencies, experience, standard nurse patient ratios for the area of specialisation, job description, and skill mix.

Associated Assessment Criteria for Exit Level Outcome 10

• Identify, share, and collaboratively solve practice problems in the critical care nursing specialist area through informed decisions and sound clinical judgement
• Sought and provided appropriate and timely provision of holistic care in a healthcare continuum through awareness of one's competence.
• Patient referrals are carried out appropriately and timeously as dictated by the patient's condition and in accordance with the referral guidelines.
• Promote visible participation in the inter- and intra-professional team, recognised by the members of the team.

Associated Assessment Criteria for Exit Level Outcome 11

• Participate in the development of policies, programmes and projects, demonstrating understanding of the steps in and or levels of the development of policies, programmes and projects.
• Participate in project and policy development demonstrates knowledge of one's own role and responsibilities within the inter- and intra-professional policy/project team.
• Participate in policy development, programme and project development, demonstrates advocacy for the nursing profession and patients or clients, families, and communities in the specialist area.
• Participate in project development includes appropriate communication (negotiation, bargaining, assertiveness, persuasion, etc.).
• Provide timely and adequate feedback to relevant stakeholders as necessary.

Associated Assessment Criteria for Exit Level Outcome 12

• Demonstrates knowledge of the process and or steps of development of policies, standards, guidelines, and protocols.
• Develop of policies, standards, protocols, and guidelines involves the relevant and pre-determined stakeholders.
• Develop and evaluate guidelines and protocols that use the appropriate methods.
• Implement new policies, protocols, and guidelines in the specialist area that demonstrate understanding and application of the change process.
• Develop policies, protocols, and guidelines collaboratively at appropriate intervals and approve as per the institutional policy for the specialist area.

INTEGRATED ASSESSMENT

The assessment strategy for the qualification comprises formal and informal assessments. Informal assessments are used during facilitation and as part of the consolidation of what the learner may have learnt on their own. They provide an opportunity for lecturers to establish learners' understanding of the subject matter. This includes the following strategies, which serve as both teaching and assessment strategies:

• Flipped class: Learners will be given content to read on their own, and in class, reflect on what they have learnt. Questions on the application of the theory will be asked to determine their level of understanding.
• Group discussions: Small group discussions will provide an opportunity for the lecturer to observe a few learners discussing a specific assigned topic in a limited period, thus determining the depth of their understanding of the subject matter.

Presentations: Learners will be asked to do presentations in class on selected topics. These may be done in summary form. The lecturer will be able to gauge the learners' level of understanding.

• Jigsaw: Learners will be divided into groups to discuss and learn about a topic in class. Individual learners will be assigned specific focal areas in each group. Each learner will have an opportunity to present to their group, and consolidation in each group is done before further presentation to the class. This will provide an opportunity for a lecturer to determine the learners' ability to participate in a group and their appreciation of collaboration and cooperation.
• Simulation: It will provide an opportunity for a student to see the relevance of their learning in the practice environment, while it provides the lecturer with an opportunity to observe the learners performing in a controlled, safe environment. This is more relevant in adult critical care nursing as adult critical care nursing techniques need to be practiced before exposure to real-life situations.
• Demonstrations: Learners will demonstrate specific skills in both simulated and real-life situations during supervision. Lecturers will have the opportunity to observe student performance individually or in a group.
• Role Play: This assessment approach in adult critical care nursing provides an opportunity for learners to practice skills such as continuous ambulatory peritoneal dialysis (CAPD). Lecturers observe learners' level of clinical competence and provide feedback for improvement where necessary.
• Debate: Debates will be applied wherein learners are given a topic to debate about, especially the application of legal prescripts in practice, e.g., the Scope of practice of a nurse during emergency endotracheal intubation in the absence of a medical officer. The lecturer can be a moderator while observing the level of understanding on the learners' part.

Formal assessments will be in the form of formative and summative assessments. Formal assessments will determine learners' progression between semesters and completion of training.

Formative Assessments

Formative assessments will contribute 30% towards the final mark in the module. The assessment content will be commensurate with the percentage contributed by the formal assessment.

Theory: The following strategies will be used to assess learners' cognitive grasp of the subject matter: written tests, assignments, case studies, a project (quality improvement project), and clinical assessments in real-life situations. Integration of theory and practice approach will be applied in all assessments; however, theory and work-integrated learning will be assessed separately, and marks will be published separately. Formative clinical assessments are conducted in the clinical areas, and their average percentage contributes 30% towards the final clinical nursing result.

Summative assessments

Summative assessments will be conducted at the end of each semester. They contribute 70% towards the final examination result. Theory examination papers will be set for each module. Work-integrated learning will be assessed in the form of a comprehensive clinical examination in each semester. This comprehensive examination will embrace all the modules that have a clinical component in a semester.

Work-integrated learning is assessed separately and must be passed for the student to complete training.