Postgraduate Diploma in Emergency Nursing

The purpose of the Postgraduate Diploma in Emergency Nursing is to strengthen and deepen the learners' knowledge and practice Emergency Nursing as a speciality. The qualification will enable the Emergency Nurse Specialist to engage in their respective specialist areas of practice with in-depth knowledge, skills, attitudes and values to enhance professional independence and health outcomes.

To produce an independent, competent, critical, and analytic Emergency Nurse Specialist who can demonstrate competencies required to render appropriate and skilled emergency nursing services to individuals with diverse health problems.

Emergency nurses are prepared to take care of foreseeable emergencies, skilled at identifying life-threatening problems, can prioritise care, and carry out resuscitative measures. The Emergency Nurse will use clinical judgement and critical reasoning skills to manage patients seeking emergency care and consequently implement interventions to restore health, preventing complications, and maintaining optimal outcomes for all patients.

Rationale

South Africa (SA) released the crime statistics for the third quarter of 2021 -2022, whereby 21,188 road rage incidents and 1215 attempted murder cases were reported, which led to grievous bodily harm. The research reports that road rages are often very aggressive, ending up in assaults and, in a worst-case scenario, murder. In a census report by Stats SA in 2022, it was reported that 2.1 % of the mortality rate in SA occurs during adolescence, mainly due to mental health issues, alcohol and drug use, early and unprotected sex with multiple partners, which carries a high risk of acquiring HIV infections and other sexually transmitted infections, as well as teenage pregnancy.

The COVID-19 pandemic also harmed the Trauma and Emergency Departments. During the COVID-19 pandemic, SA experienced an increased number of deaths, resulting in a significant rise in the crude death rate from 8.7% per 1000 people in 2020 to 11.6% per 1000 people in 2021. This resulted in a drop in life expectancy and consequently a drop in the working population, which led to economic devastation (Stats SA, 2022).The World Health Organization (WHO) considers self-harm to be a significant public health issue, as 800,000 people die each year because of suicide. South Africa reported 0.098% of deaths resulting from unintentional human poisoning and 1.51% due to self-harm. The Gauteng Province was reported as having a high number of poisonings annually.

Violent riots and looting increase the workload of the health sector, which is constantly under strain and affects the provision of resources as ambulances get torched, impacting the transportation of patients between institutions. South Africa is a patriarchal society where men oppress women and subject them to physical and psychological abuse. The nation is in a fragile state due to the low output of nurses with clinical expertise.

No similar qualification exists in the Gauteng Province. The institution has indicated an interest in offering the qualification, given the prevalence of accidents and injuries in SA, particularly on national roads during holidays and the festive season.

The transformation of nursing education in the country resulted in a decline in the number of Emergency Nurse Specialists trained for the previous three (3) years. This harmed the output of Specialist Nurses in general. Emergency Nursing qualification is a scarce skill that is required to increase access to the provision of quality emergency care in low- and middle-income populations. The knowledge and skills acquired by the Emergency Nurse Specialist will help prepare them to take care of foreseeable emergencies, be skilled at identifying life-threatening problems, prioritizing the urgency of care, rapidly and effectively carrying out resuscitative measures, and other treatments. Emergency Nurse Specialists care for patients of all ages in an emergency and/or critical phase of their illness or injury, focusing on the level of severity and time-critical interventions with or without advanced technology.

SANC Regulation No. 635 of 2020 prescribes the requirements for registration in the category of Nurse Specialist. The candidate must meet the following to be admitted to the qualification: -

• A minimum of two (2) years' experience after registration as a: -
• Professional Nurse or
• General Nurse and Midwife.
• In the two years of experience, one (1) year should be in an emergency unit. Such experience should cover medical and trauma emergency units.

The Emergency Nurse Specialists will operate in various emergencies, trauma, and intensive care unit settings. They are required to work with ill patients by assessing and initiating care for patients of all ages who require immediate emergency care to reduce the high mortality rate

On successful completion of the qualification, the qualifying learner will be awarded a Postgraduate Diploma in Emergency Nursing, pegged at NQF Level 8, conferred by the College, according to the South African Nursing Council (SANC) Education and Training Postgraduate Diploma Programmes Guidelines (2020). On successful completion of the qualification, the qualifying learner will be registered as an Emergency Nurse Specialist with the SANC as defined by the Nursing Act 33 of 2005. The registration is renewable on an annual basis.

Emergency Nurses Society of SA (ENSSA) and Advanced Trauma Life Support (ATLS) are independent professional organisations that exist in SA, where voluntary membership is offered to Emergency Nurse Specialists to affiliate on an annual basis. The purpose of the collaboration is to broaden knowledge, skill, networking, and benchmarking for best practices, including participating in the development and revision of guidelines.

Recognition of Prior Learning (RPL)

RPL for access

The institution admits learners from various educational qualifications, some of which have been acquired from other institutions and are in line with the content of the courses offered by the institution.

RPL for exemption

• Assessment of informal and non-formal learning for the purpose of exemption from modules (a maximum of 50% of a qualification) will be rigorous.
• Learners will receive a written response setting out the requirements that must be met.
• An effective academic support programme will be put in place to assist these learners.

Entry Requirements

The minimum entry requirement for this qualification is

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

Or

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

Or

• Bachelor of Nursing and Midwifery (R.174), NQF Level 7.

Or

• Bachelor of Nursing in Education and Administration, NQF Level 7. And
• Registered Nurse with Midwifery qualification/s (Degree / Diploma in Nursing (General, Community Health, Psychiatric) and Midwifery (R. 425), Bridging Course for Enrolled Nursing Leading to Registration as a General Nurse (R.683) with Diploma in Midwifery (R.254); or Diploma in General Nurse (R.171) with an Advanced Diploma in Midwifery (R.1497)
• Proof of current SANC registration as a Professional Nurse or General Nurse with Midwifery
• Have at least two (02) years' experience as a Professional Nurse or General Nurse and Midwife.

This qualification consists of the following compulsory modules at National Qualifications Framework, Level 8, totalling 144 Credits.

Compulsory Modules at NQF Level 8, 144 Credits

• Health Service Dynamics, 6 Credits.
• Health Science Research, 5 Credits.
• Emergency Nursing Speciality I, 18 Credits.
• Emergency Nursing Speciality II, 29 Credits.
• Emergency Nursing Work Integrated Learning (WIL), 86 Credits.

1. Practice and facilitate specialised Emergency Nursing within ethical-legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice in the specialised emergency nursing care to solve contextual problems and develop policies and guidelines
3. Appraise and develop self, peers, and emergency nursing learners by facilitating self-directedness/leadership and lifelong learning to maintain competence.
4. Facilitate advocacy for the profession and provide specialised emergency professional support for personnel, patients, families, and communities.
5. Engage in planning, commissioning, and managing a specialist emergency nursing unit.
6. Engage in scholarly activities to inform evidence-based Emergency Nursing practice.
7. Utilize, manage, and communicate data to support decision-making and research.
8. Render and coordinate patient-centred specialist nursing or emergency 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 the area of specialisation, to ensure quality patient care and safety.
10. Collaborate within the inter-professional team by engaging in health dialogue, shared leadership, decision-making and sound clinical judgment.
11. Participate in the design, development, implementation, and evaluation of nursing policies, programmes, and projects that relate to emergency practice at provincial or national level.
12. Develop and implement institutional policies, protocols, and guidelines in the emergency specialisation, utilising the process of change management in the improvement of quality of care.

Associated Assessment Criteria for Exit Level Outcome 1

• Conform to the relevant code of ethics for the emergency nursing specialist practice.
• Use critical decision-making and moral reasoning models and principles to make clinical judgements and resolve ethical dilemmas within the emergency nursing specialist practice.
• Become accountable for own professional judgement, actions, outcomes of specialist care provided, and continued competence.
• Identify and apply the relevant current legislation, policies, regulations, and guidelines of specialist practice.
• Document all care activities accurately, comprehensively, and timeously, considering the legal requirements for record keeping.
• Discuss the role of the emergency nurse specialist in the management of risk-taking, taking into consideration the institutional protocols and ethical-legal framework.

Associated Assessment Criteria for Exit Level Outcome 2

• Engage in the emergency specialist practice, demonstrating understanding of and the process of evidence-based practice.
• Apply evidence-based emergency specialist practice that takes into consideration the appropriate methodology of gathering evidence for practice, for example, systematic or scoping reviews, appraisal of articles, practice-based research, and publication.
• Use evidence-based emergency specialist practice to demonstrate knowledge of and critical analysis of the various levels of evidence.

Associated Assessment Criteria for Exit Level Outcome 3

• Apply leadership skills, appropriate leadership styles, principles, and theories of health services management.
• 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, and performance appraisal.
• Discuss the purpose and processes of the performance management and development system in performance appraisal.
• Utilise feedback gained from self-reflection, peers, learners, management, and other relevant stakeholders to improve effectiveness in the specialist role.
• Discuss 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

• Discuss the purpose of the advocacy role for an emergency nurse specialist practice.
• Apply advocacy principles to ensure safe and quality care in various healthcare settings.
• Apply appropriate communication skills and channels in advocacy.
• Lobby and/or participate in interest groups to influence legislation and policy affecting role performance.

Associated Assessment Criteria for Exit Level Outcome 5

• Explore the levels and/or classification of the specialised emergency units.
• Commission task taking into consideration the burden of diseases and priority services as determined by current events.
• Participate in the evaluation of the existing specialised emergency unit and demonstrate knowledge of guidelines for provisioning such a unit.
• Engage in planning and commissioning to demonstrate an understanding of the role and responsibilities in this task within inter- and intra-professional teams.

Associated Assessment Criteria for Exit Level Outcome 6

• Practice in the specialised emergency practice and demonstrates knowledge of appropriate search engines and databases for review of literature to inform evidence-based practice.
• Use appropriate emergency methods to generate evidence for utilisation in specialised emergency practice (e.g., research, systematic reviews, etc.).
• Demonstrate awareness of peer-reviewed journals and their use for sharing of evidence.
• Base activities in the specialised emergency practice on scientifically proven evidence.
• Actively participate in inter- and intra-professional dialogues, debates, or discourses in quality improvement.

Associated Assessment Criteria for Exit Level Outcome 7

• Document all data/information gathered in the context of the specialized emergency practice, for utilization and storage by the set standards.
• Use comprehensive data, information, and emerging evidence pertinent to the specialised emergency practice.
• Base problem identification, diagnoses, and opportunities for improvement on gathered and critically analysed assessment data from the patients/clients, families, communities, learners, or employees, including current scientific evidence.
• Documentation demonstrates respect for intellectual property and is without plagiarism.

Associated Assessment Criteria for Exit Level Outcome 8

• Demonstrate an understanding of the position of specialised emergency services within the health care system.
• Explain the full range of services within the specialised emergency area of practice.
• Render emergency nursing specialist care, integrate promotive, preventive, curative, and rehabilitative care in a healthcare continuum.
• Apply knowledge, skill, and attitudes in rendering emergency specialist care following national and international standards as well as protocols of the emergency nursing field.
• Formulate emergency nursing diagnoses that are congruent with the patient'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/current literature/evidence.
• Plan emergency nursing interventions are individualized considering patients'/clients' needs, values, beliefs, preferences, culture, and contextual variables, for example, disease burden, health risks, national priorities, etc.
• Plan emergency nursing interventions based on formulated nursing diagnoses, and application of specialized knowledge and skills (competencies), including advanced pharmacology in collaboration with inter and intra-professional teams.
• Implement planned emergency nursing interventions timeously, accurately, safely, and effectively following set evidence-based standards, guidelines, protocols, algorithms, etc., specific to the specialized emergency nursing field.
• Plan health care interventions in collaboration with the patient/client, family, and relevant members of the

health care team.

• Apply emergency nursing interventions, including preparation of patients/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.
• Document, timeously revise, and effectively base emergency nursing interventions on critical analysis, monitoring, and evaluation of data to reach a clinical judgement.

Associated Assessment Criteria for Exit Level Outcome 9

• Identify the infrastructure and equipment needed in the specialized emergency area of practice.
• Demonstrate the ability to operate and monitor the equipment used in the specialised emergency area of practice.
• Employ sound asset management principles to ensure appropriate, adequate, well-maintained, and up- to-date equipment.
• Assign staff to nursing care taking into consideration the Emergency Nursing Specialist's qualification and its competencies, experience, standard nurse patient ratios for the area of emergency nursing specialisation, job description, and skill mix.

Associated Assessment Criteria for Exit Level Outcome 10

• Identify, share, and collaboratively solve practice problems in the specialised emergency nursing area by informed decisions and sound clinical judgment.
• Seek and provide appropriate and timeous consultation in the provision of holistic care in a healthcare continuum through awareness of one's competence.
• Carry out patient referrals appropriately and timeously as dictated by the emergency patient's condition and by the referral guidelines.
• Participate in the inter- and intra-professional team is promoted, visible, and recognized 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 to demonstrate knowledge of own role and responsibilities within inter- and intra-professional policy/project team.
• Participate in policy development, programme and project development to demonstrate advocacy for the emergency nursing profession and patients/clients, families and communities in the specialised emergency nursing area.
• Participate in project development and include 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

• Discuss the process and or steps of development of policies, standards, guidelines, and protocols.
• Involve the relevant and pre-determined stakeholders in the process of development of policies, standards, protocols, and guidelines.
• Use the appropriate methods in the process of development and evaluation, or testing of guidelines and protocols.
• Implement the new policies, protocols and guidelines in the specialised emergency nursing area, demonstrating understanding and application of the change process.
• Collaboratively revise developed policies, protocols and guidelines at appropriate intervals and approve as per the institutional policy for the specialized emergency nursing area.