Postgraduate Diploma in Adult Critical Care Nursing

Purpose

The purpose of the Postgraduate Diploma in Adult Critical Care Nursing qualification is to strengthen and deepen the learners' knowledge and expertise in Critical Care Nursing of adult patients as a specialty. It will enable the Critical Care Nurse Specialist to engage in their specialist area of practice with in-depth knowledge, skills, attitudes, and values to enhance professional independence and optimum health outcomes. This includes preventing disease, injury, and complications.

It also entails screening, appropriate management, and prompt referral of patients with specific and complex problems in all clinical settings.

The qualification further equips the learners with facilitation of teaching and learning, including management skills at all levels of practice. The qualification provides an opportunity for further postgraduate study. Learners will have the capacity to apply high-level academic, clinical, and management skills as well as comprehensive and systematic knowledge in the specialised field of critical care nursing of adult patients.

An Adult Critical Care Nurse Specialist is found in the following workplace settings

• Primary and community care rapid response teams
• Medical emergency and trauma settings
• High acuity and high dependency care units at various levels
• Intensive care units
• Settings of care and specialist services for adults who require complex long-term and rehabilitation care.

Upon completion of the qualification, a qualifying learner will be able to

• Apply knowledge of and facilitate evidence-based practice in the specialist field to solve contextual problems and develop policies and guidelines.
• Appraise and develop self, peers, and nurse specialist learners by facilitating self-directedness/leadership and lifelong learning to maintain competence.
• Facilitate advocacy for the profession and provision of specialist professional support for personnel, patients, families, and communities.
• Engage in planning, commissioning, and managing a specialist unit.

Rationale

The South African health care system has adopted a primary health care approach, which is nurse-led and needs nurses with in-depth knowledge to engage at the forefront of a specialist field with an understanding of theories, methodologies, methods, and techniques to apply in a particular context.

The healthcare system, again in the interest of the right of access to health, enshrined in the Constitution of South Africa (Act No. 108 of 1996), is embarking on a National Health Insurance (NHI) system to promote access to quality, essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines for all. This approach is in response to an increase in the burden of disease from quadruple diseases, including communicable diseases (predominantly HIV and AIDS and TB), non-communicable diseases (hypertension, diabetes mellitus, cancer), and injury-related disorders.

The COVID pandemic and the admission of adult patients with multiple co-morbidities to critical care units have brought the importance of this specialist role to the fore. Furthermore, the NHI system has necessitated a focus on quality care to ensure patient safety and good patient outcomes, which the knowledgeable Nurse Specialist can drive. While the 17 Sustainable Development Goals (SDGs) promote inter-sectoral collaboration, the Nurse Specialist is appropriately positioned to ensure healthy lives and promote the well-being of persons admitted to adult critical care units through their active engagement in promotive, preventive, curative, and developmental health services, representing components of the primary Health Care approach. More specifically, Critical Care Nursing supports the primary health approach in South Africa, hence the adoption of the concept Critical Care Nursing rather than Intensive Care Nursing, the latter being a component of the former.

To align Critical Care Nursing to the Primary Health Care Approach, the Critical Care Nurse Specialist proposes to adopt Comprehensive Critical Care, which includes both Preventive (initiating action with urgency) and Reactive Critical Care Nursing (conventional critical care).

Critical Care Nursing is the care of patients with life-threatening illnesses and injuries, and it occurs within a continuum from the scene of initial incident or onset of critical illness, through stabilisation, transfer/transportation, emergency and intensive care, up to and including transfer to care in lower acuity levels/step down units. Critical care is complex care that includes the use of technology by highly skilled and knowledgeable nurses within a multidisciplinary healthcare team. Care of the critically ill adult patient includes having excellent interpersonal skills to assist the family/support system to deal with complex situations.

The focus of Midwifery is to care for the health needs of childbearing women, including adolescents, newborn infants, and families across the continuum throughout pre-pregnancy, pregnancy, birth, post-partum, and the early weeks of life. Midwifery services are a core part of universal health coverage.

In their practice, nurses and midwives encounter people in various age ranges, stages of health and illness, and individuals and families or larger groups of people. Therefore, central to their practice is a commitment to interpersonal relationships and partnership.

Postgraduate Diploma in Critical Care Nursing of adult patients will provide specialist training for nurses locally and internationally, and will qualify successful candidates for registration with the South African Nursing Council (SANC) as a Nurse Specialist.

The qualification provides an opportunity for further postgraduate study. Learners will have the capacity to apply high-level academic, clinical, and management skills as well as comprehensive and systematic knowledge in the specialised field of critical care nursing of adult patients.

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

At this stage, there is no anticipated RPL for access.

The SANC's Education and Training Guideline for Postgraduate Diplomas is specific with regard to 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. The future possibility of RPL for access may be an implementable option in the case of

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

• Registration with the SANC as a Professional Nurse and Midwife.

or

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

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

Compulsory modules, Level 8, 120 Credits

• Foundations of Specialist Practice, 24.
• Leading Quality and Safety in Adult Critical Care Nursing, 16.
• Principles of Adult Critical Care Nursing, 40.
• Adult Critical Care Nursing Practice, 40.

1. Practice and facilitate specialist critical care nursing within ethical-legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice in the specialist field to solve contextual problems and develop policies and guidelines.
3. Appraise and develop self, peers, and nurse specialist learners by facilitating self-directedness or leadership and lifelong learning to maintain competence.
4. Facilitate advocacy for the profession and provision of specialist professional support for personnel, patients, families, and communities.
5. Engage in planning, commissioning, and managing a specialist unit.
6. Engage in scholarly activities to inform evidence-based practice.
7. Utilise, manage, and communicate data to support decision-making and research.

Associated Assessment Criteria for Exit Level Outcome 1

• Conform to the code of ethics in the practice of specialist nursing.
• Apply critical decision-making and moral reasoning models and principles for clinical judgement and to resolve ethical dilemmas within the specialist practice.
• Account for own professional judgment, actions, outcomes of specialist care provided, and continued competence.
• Define and apply current relevant legislation, policies, regulations, and guidelines about specialist practice.
• Evaluate documentation for plagiarism in accordance with the relevant legislation.
• Manage professional misconduct according to institutional protocols and professional ethical/legal frameworks.

Associated Assessment Criteria for Exit Level Outcome 2

• Engage in specialist practice and show understanding and the process of evidence-based practice.
• Apply evidence-based specialist practice taking into consideration the appropriate methodology of gathering evidence for practice, for example, systematic or scoping reviews, appraisal of articles, practice-based research, and publications.
• Apply evidence-based practice that shows knowledge and critical analysis of the various levels of evidence.

Associated Assessment Criteria for Exit Level Outcome 3

• Apply leadership skills that are demonstrated through application of appropriate leadership styles, principles, and theories in critical care health services.
• Effectively 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 demonstrates understanding of the purpose and processes of the performance management and development system.
• Utilise feedback gained from self-reflection, peers, learners, and management to improve effectiveness in the specialist role
• Identify and apply various risk factors for stress and burnout at the workplace and strategies used to care for oneself and peers/employees/learners.

Associated Assessment Criteria for Exit Level Outcome 4

• Examine the purpose of the advocacy role for a nurse specialist.
• Apply advocacy principles to advocate for safe and quality care in healthcare institutions
• Apply appropriate communication skills and channels.

Associated Assessment Criteria for Exit Level Outcome 5

• Commission and show understanding of levels and or classification of critical care specialist units.
• Take 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, plan, and commission with an understanding of the role and responsibilities in this task within the inter-professional team.

Associated Assessment Criteria for Exit Level Outcome 6

• Apply knowledge and competence of the adult critical care using 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.
• Illustrate awareness and use of peer-reviewed journals for sharing of evidence.

Associated Assessment Criteria for Exit Level Outcome 7

• Documents all data or information gathered in the context of the specialist practice for utilisation and storage in accordance with set standards.
• Utilise specialist practice with comprehensive data, information, and emerging evidence pertinent to the context
• Document all data or information gathered in the context of the specialist practice for utilisation and storage in accordance with intellectual property, and without plagiarism.

INTEGRATED ASSESSMENT

All assessments are aligned with the Assessment Policy of the institution to provide a safe and effective learning environment, free from harassment, intimidation and discrimination, support and developmental opportunities for teaching, and to provide all reasonable facilities and structures to support learners success.

Continuous (formative) assessment during the year contributes 40% of the final year mark for three courses and 50% for the Practice course; summative evaluation at the end of the year contributes 50>60% of the final year mark, depending on the course, and as approved by the Health Sciences' Faculty Board.

Assessment weightings and strategies as specified for each course are published in the Faculty of Health Sciences Postgraduate Handbook annually. A minimum of 80% of the summative assessment for the clinical courses will be conducted in real-life situations.

Formative and Summative Assessment

There is continuous integration of theory and practice throughout the period of the qualification. The assessment approach is to use formative, continuous, and summative assessments of learning in the form of:

• Written and clinical examinations
• Assignments
• Individual and group projects
• Portfolios and teaching practice for integrated learning

An ability to apply theory to practice is tested.