Postgraduate Diploma in Emergency Nursing

Purpose

The purpose of the Postgraduate Diploma in Emergency Nursing is to strengthen and deepen the learners' knowledge and expertise in emergency nursing as a speciality. It will enable these emergency clinical nurse specialists to undertake advanced reflection and development using a systematic survey of current thinking, practice, and research in adult critical care.

The qualification aims to develop a clinical nurse specialist who will use specialist conceptual understanding and professional competence to enhance patient care. This includes preventing disease, injury, and complications through screening, appropriate management, and prompt referral of patients with specific and complex problems in all clinical settings. The qualification will provide a high level of theoretical engagement, sound clinical judgment, and intellectual independence, as well as the ability to relate knowledge and transfer understanding to a range of contexts. The learner with this qualification will be eligible for registration with the South African Nursing Council (SANC) as an emergency specialist nurse.

On successful completion of this qualification, qualifying learners will be able to

• Practice and facilitate specialist nursing within ethical-legal parameters of the profession.
• Apply the 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.
• Facilitates advocacy for the profession and provision of specialist support for personnel, patients, or clients, families, and communities.
• Engage in planning, commissioning, and managing a specialist unit.
• Engage in scholarly activities to inform evidence-based practice, education, or management.
• Utilise, manage, and communicate data to support decision-making and research.
• Render and co-ordinate patient-centred specialist nursing within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences, including advanced pharmacology.

Rationale

Offering qualifications that will qualify nurses with specialist emergency competencies in South Africa is important to address the shortages reported and provide better care for critically ill and injured patients and improve patient outcomes, as well as keep up with advancements in the field.

Critical shortages of specialist nurses, including specialist emergency nurses, have been reported in South Africa, so that the demands for this level of care cannot be met. At present, there is limited exposure of pre-registration nurses to speciality emergency nursing during their education qualifications. The ongoing complexity of technology and the high acuity levels of the patients being cared for demand in-depth knowledge and a specialist level of skills and competencies. This qualification will address the grave shortage of specialist clinical nurses who are competent to nurse highly compromised patients.

According to the World Health Organization, South Africa has a quadruple burden of disease which includes non- communicable diseases (33%), HIV/AIDS and tuberculosis (25.5%), injuries and violence (11.5%) and maternal and neonatal deaths (21.7%) (Scott and Brysiewicz, 2016:60). Emergency nursing specialist qualifications addressed in this curriculum involve the care of critically ill and injured patient populations, namely Qualified trauma and emergency nurses in South Africa are in short supply amid high demands for their knowledge and skills. According to the South African Nursing Council (SANC) statistics for 2022, a total of 1,106 trauma and emergency nurses were registered with the additional qualification. At the same time, South African emergency departments are overwhelmed with critically ill and injured patients daily. The critically ill and injured patients range from "polytrauma" to multiple medical diagnoses, which further pressurise departments due to the ever-fluctuating acuity levels.

One of the leading causes of unnatural deaths in South Africa at present is trauma, which is affecting the economy with increasing costs. Approximately 40 people die on average each day in South Africa due to the physical trauma they have suffered. In acute care facilities, the first healthcare providers who interact with these ill or injured patients are the emergency nurses, who are expected to care for these patients with high-quality emergency care. For this reason, trauma and emergency nurses require adequate education and training in appropriate trauma and emergency skills.

Emergency nursing is a constant, complex, detailed health care provided for patients with various acute life-threatening conditions. As the world's population ages, and with new and re-emerging health priorities, such as Ebola, Haemorrhagic Fever (HF), the Middle East Respiratory Syndrome (MERS-CoV), Severe Acute Respiratory Syndrome (SARS) and Coronavirus (COVID-19) disease, the high prevalence of violence and injuries, and other conditions that increase the population's morbidity and mortality, there is an expectation that emergency care will be available on demand to all who need it. Registered nurses (RNs) provide most emergency care in emergency departments; however, only a small percentage of nurses in the emergency department are qualified.

In 2022, the South African Nursing Council (SANC) statistics recorded a total of 1106 Registered Nurses with the additional qualification in Trauma and Emergency Nursing and 487 Registered Nurses with the additional qualification in Emergency Nursing. It is not known how many of these qualified nurses are currently working in EDs in South Africa. In South Africa, with its high burden of disease and injury and consequent high demand for such a level of care, the emergency nurse specialist is in demand, and education and training for emergency nurses are therefore of paramount importance.

This qualification will enable the learner to function as a leader who is a clinically focused, service-oriented, autonomous, and innovative, and able to render comprehensive, scientific emergency care, as determined by the appropriate legislative framework. In addition, this qualification will address the grave shortage of specialist clinical nurses who are competent to nurse these highly compromised groups of patients.

The target learner population for this qualification includes nurses with an Advanced Diploma in Midwifery, a Bachelor of Nursing Degree, or a 4-year Diploma in Nursing and Midwifery (Reg. 425) registered with the SANC, interested in specialising in critical care nursing. In general, entrants arise from Generation X and Generation Y (millennials), and, since nursing is a female-dominated profession, the majority will be female. Based on experience with previous post-basic qualifications, most of these entrants will be in the middle-income group and will be permanent employees with complex social responsibilities. Learners are internally motivated to improve their lives.

The entrant arises from the pre- and post-2000 schooling system. Some learners have challenges in learning and assessment, due to varying exposure and limitations in the South African nursing education system. Most learners will be studying with English as a second language (ESL), as South Africa has 11 official languages. Furthermore, with the increased exposure to technology in society, Netcare Education has adopted a strategic objective of technology enablement; hence, it is expected that all learners will have personal smartphone devices and laptops or personal computers.

RPL for access

• RPL for access applies to learners who do not meet the minimum entrance requirements or the required qualification 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, should they be allowed entrance into the qualification.
• A maximum of ten per cent (10%) of learners in a cohort will be admitted through an RPL process.

RPL for exemption from modules

• For access to this qualification or credit-bearing exemptions, an application must be submitted according to the institution's RPL and credit accumulation and transfer (CAT) policy and RPL SOP for individual assessment.
• A maximum of 50% of credits will be granted through CAT.
• A maximum of 50% of credits for a qualification will be granted for access or articulation into the qualification. > Such credits will be granted based on certified learning at an accredited institution that occurred five years or less from the date of application for the qualification.

Entry Requirements

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

Or

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

Or

• Bachelor of Nursing Degree, NQF Level 8.

Or

• General Nurse with an Advanced Midwifery qualification, NQF Level 7.

Or

• 4-year Diploma in Nursing and Midwifery, NQF Level 7.

And

• Registered Professional Nurse and Midwife with SANC for two years (community service year included) as a General Nurse and Midwife or Professional Nurse and Midwife.

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

Compulsory Modules, NQF Level 8, 120 Credits

• Professionalism, 4 Credits.
• Evidence-Based Practice (Research), 8 Credits.
• Advocacy, 8 Credits.
• Clinical Leadership, 4 Credits.
• The Emergency Environment, 9 Credits.
• Emergency Healthcare Principles, 9 Credits.
• Gas Exchange, 18 Credits.
• Perfusion, 18 Credits.
• Neurological Integrity, 13 Credits.
• Biochemical Balance, 12 Credits.
• Mobility and Tissue Integrity, 12 Credits.
• Inflammation, 6 Credits.

1. Demonstrate the ability to practice and facilitate specialist nursing within ethical-legal parameters of the profession.
2. Demonstrate the ability to apply the knowledge of and facilitate evidence-based practice in the specialist field to solve contextual problems and develop policies and guidelines.
3. Demonstrate the ability to appraise and develop self, peers, and nurse specialist learners by facilitating self-directedness/leadership and lifelong learning to maintain competence.
4. Demonstrate the ability to facilitate advocacy for the profession and provision of specialist support for personnel, patients or clients, families, and communities.
5. Demonstrate the ability to engage in planning, commissioning, and managing a specialist unit.
6. Demonstrate the ability to engage in scholarly activities to inform evidence-based practice, education, or management.
7. Demonstrate the ability to utilise, manage, and communicate data to support decision-making and research.
8. Demonstrate the ability to render and coordinate patient-centred specialist nursing 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 emergency nursing, to ensure quality patient care and safety.
10. Demonstrate the ability to collaborate within the inter- and intra-professional team by engaging in health dialogue, shared leadership, decision making, and sound clinical judgement.
11. Demonstrate the ability to participate in the design, development, implementation, and evaluation of nursing policies, qualifications, and projects at the provincial or national level.
12. Demonstrate the ability to develop and implement institutional policies, protocols, and guidelines in emergency departments, 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 emergency nurse specialist role 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 nursing specialist practice, 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, for example, systematic or scoping reviews, appraisal of articles, practice-based research, and publication.
• Critically analyse the various levels of evidence in nursing specialist practice.

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 levels and/or classification of the emergency nursing specialist units.
• Commission task consideration of the burden of diseases and priority services as determined by current events.
• Develop guidelines for the evaluation and provisioning of the existing emergency nursing specialist unit.
• Discuss the role and responsibilities within the inter- and intra-professional team in planning and commissioning.

Associated Assessment Criteria for Exit Level Outcome 6

• Use appropriate search engines and databases for literature review in emergency nursing care to inform evidence-based practice.
• Use appropriate methods to generate evidence for utilisation in emergency nursing specialist practice (e.g., research, systematic reviews, etc.).
• Consult peer-reviewed journals and use them for evidence.
• Base activities in the specialist 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 emergency nursing specialist practice for use and storage per standards.
• Use comprehensive data, information, and emerging evidence pertinent to the emergency nursing specialist practice.
• Identify problems, diagnosing, and opportunities for improvement is based on gathering and critically analysing assessment data from the patients/clients, families, communities, learners, or employees, including current scientific evidence.
• Respect intellectual property and minimise plagiarism in documentation.

Associated Assessment Criteria for Exit Level Outcome 8

• Explain the position of the emergency nursing specialist service within the health care system.
• Discuss the full range of services within the emergency nursing specialist area of practice.
• Render emergency nursing specialist care, integrate promotive, preventive, curative, rehabilitative, and palliative care in a healthcare continuum.
• Render emergency nursing specialist care per national and international standards and protocols of the specialist field.
• Formulate emergency nursing or midwifery diagnoses that are congruent with the patient's/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/current literature/evidence.
• Plan emergency nursing or midwifery interventions that are individualised considering patients'/clients' needs, values, beliefs, preferences, culture, and contextual variables, for example, disease burden, health risks, national priorities, etc.
• Plan emergency nursing or midwifery interventions based on formulated nursing diagnoses, and application of specialised knowledge and skills (competencies), including advanced pharmacology in collaboration with the inter- and intra-professional team.
• Implement emergency nursing or midwifery interventions timeously, accurately, safely, and effectively per set evidence-based standards, guidelines, protocols, algorithms, etc., specific to the emergency nursing specialist field.
• Plan health care interventions in collaboration with the patient or client, family, and relevant members of the health care team.
• Prepare 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/client.
• Document and revise emergency nursing or midwifery 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

• Identify the infrastructure and equipment in the emergency department.
• Render care, operate, and monitor the equipment used in the emergency nursing specialist area.
• Employ sound asset management principles to ensure appropriate, adequate, well-maintained, and up-to-date equipment.
• Assign staff to consider nursing care, the emergency nursing specialist qualification and competencies, experience, standard nurse patient ratios for emergency care, job description, and skill mix.

Associated Assessment Criteria for Exit Level Outcome 10

• Identify, share, and solve collaborative practice problems in the specialist area, make informed decisions, and sound clinical judgement.
• Provide appropriately and timeously holistic care and seek consultation in a healthcare continuum through awareness of one's competence.
• Carry out patient referrals appropriately and timeously as dictated by the patient's condition and referral guidelines.
• Promote, visible and recognise member participation in the inter- and intra-professional team.

Associated Assessment Criteria for Exit Level Outcome 11

• Discuss the steps in and/or levels in the development of policies, programmes, and projects.
• Examine own role and responsibilities within the inter- and intra-professional policy/project team in project and policy development.
• Participate in policy development, programme and project development to demonstrate advocacy for the nursing profession and patients/clients, families and communities in the specialist area.
• Apply appropriate communication (negotiation, bargaining, assertiveness, persuasion, etc.) in project development
• 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 development of policies, standards, protocols, and guidelines.
• Use appropriate methods in the development and evaluation, or testing of guidelines and protocols.
• Apply the change process to implement the new policies, protocols, and guidelines of the emergency nursing specialist area
• Collaboratively revise developed policies, protocols, and guidelines at appropriate intervals and approve as per the institutional policy for the specialist area.

Integrated Assessment

The qualification aligns with all the processes and procedures described in the assessment strategy below, which is further described in the assessment SOP (NetEd AAS 029) submitted with the institutional profile

Formative and continuous assessment of the qualification will be conducted by campus-based or hospital-based academic staff who are registered, constituent assessors. Moderation of the assessment will be conducted by registered constituent moderators. No more than 20% of the assessment will be conducted in simulation.

Each learning unit (concept) in the qualification will be assessed continuously and accumulate a mark per concept, stipulated as the concept mark. Each concept carries a different weighting towards the overall continuous assessment mark, based on the number of credits per concept.

For the Specialist Professional Practice (SPP) module of this qualification, continuous assessments are integrated, and the cumulative mark for this module will be the final mark. SPP module concepts will be continuously reinforced and integratively assessed in the Emergency Nursing Science (ENS) module. The concepts (Learning Units) of the SPP module, the credit value of each concept, and the percentage contribution to the final mark are as follows:

Professionalism: assessment results cumulatively contribute 15% towards the module final mark. Assessments integrate theory and clinical components and include:

• Participation in tutorials: 5%
• Formulate a personal commitment statement: 5%
• Answer Shelley Cohen's questions: 30%
• Demonstration of exemplars: 60%

Evidence-Based Practice: assessment results cumulatively contribute 35% towards the module final mark. Assessments integrate theory and clinical components and include:

• Puzzling questions group work: 5%
• EBP assignment: 70%
• Audits and QIP: 25%

Advocacy: assessment results cumulatively contribute 35% towards the module final mark. Assessments integrate theory and clinical components and include:

• Participation in tutorial session: 5%
• Participation in group work assignment: 10%
• Recordkeeping audit: 10%
• Patient handover: 10%
• In-service training session on rapid response: 15%
• Whistleblowing assignment: 50%

Clinical Leadership: assessment results cumulatively contribute 15% towards the module final mark. Assessments integrate theory and clinical components and include:

• Participation in tutorial: 5%
• Self-assessment of competencies: 30%
• Portfolio of evidence from WIL experience: 60%

For the ENS module of this qualification, there will be continuous assessments for both theory and clinical components. There is a high-stakes leg for theory and clinical, which contributes 50% to the final component mark, and there is a low-stakes leg, which contributes 50% to the final component mark.

Theory assessments

- Low-stakes continuous assessments per concept

Emergency Department Environment: assessment results cumulatively contribute 5% towards the final component mark, and include the following assessments:

• Preparation and participation in answering the conceptual question: 5%
• Poster on the role and benefit of the ED in the healthcare system: 15%
• Create a checklist of standards and guidelines for an ED: 5%
• Prepare 2 questions for the clinical engineer about commissioning of an ED: 5%
• List of factors contributing to risk in the ED: 5%
• Participate in debate and defend viewpoint: 5%
• Assess the safety of the ED and interview 2 pts and/or family members: 5%
• Create a checklist about the risks of the ED as a work environment: 5%

Emergency Healthcare Principles: assessment results cumulatively contribute 10% towards the final component mark and include the following assessments:

• Participate in group discussion and debate: 5%
• Critique the application of healthcare principles: 5%
• Forensic principles and chain of evidence: 10%
• Evaluation of videos: 10%
• Case study presentation: 20%

Gas Exchange: assessment results cumulatively contribute 20% towards the final component mark and include the following assessments:

• Online pre-knowledge quiz: 5%
• Exemplar 1 questions regarding noticing gas exchange problems: 10%
• Exemplar 1 part 2 regarding management of a gas exchange problem: 10%
• Exemplar 2 questions to solve an unfamiliar gas exchange problem: 10%
• Tanner's Clinical Judgement reflection: 5%
• Online quiz: 10%

Perfusion: assessment results cumulatively contribute 20% towards the final component mark and include the following assessments:

• Narrative about data extracted from patient file: 10%
• Peer teaching: 5%
• Case presentation: 15%
• Tanner's Clinical Judgement Model reflection: 5%
• Online assessment:15%

Neurological integration: 5 theory credits, assessment results cumulatively contribute 15% towards the final component mark and include the following assessments:

• Discussion of the conceptual question: 5%
• Case study: 10%
• Tanner's clinical judgement reflection: 5%
• Peer teaching and assessment: 10%
• Case study: 20%

Biochemical balance: 5 theory credits, assessment results cumulatively contribute 15% towards the final component mark, and include the following assessments:

• Pre-knowledge quiz on Insight: 5%
• Extracting biochemical information and writing a report on findings: 10%
• Peer teaching: 15%
• Knowledge questionnaire (Written assessment): 20%

Mobility and Tissue Integrity: assessment results cumulatively contribute 10% towards the final component mark, and include the following:

• Online pre-knowledge quiz: 5%
• Participation and discussion of exemplar problem solving: 15%
• Written report of analysis of resuscitation documentation: 20%
• Peer teaching and assessment: 10%

Inflammation: assessment results cumulatively contribute 5% towards the final component mark and include the following

• Pre-knowledge quizzes: 10%
• Poster comparing local and systemic inflammation: 10%
• Interview with a patient regarding their pain experience: 10%
• Pain management assignment: 15%
• Reflection: 5%

Formative assessments

High-stakes continuous assessments

• Written assignment about emergency healthcare principles and gas exchange: 20%
• Knowledge questionnaire about emergency healthcare principles, gas exchange, perfusion, and neurological integration: 30%
• Knowledge questionnaire about emergency healthcare principles, gas exchange, perfusion, neurological integration, biochemical balance and mobility, and tissue integrity: 50%

Clinical assessments

- Low-stakes continuous assessments per concept

Emergency Department Environment: WIL assessment results cumulatively contribute 5% towards the final component mark and include the following assessments:

• Audit an emergency department using the developed checklist: 5%
• Morbidity and Mortality report: 10%
• Audit the safety of the emergency environment: 5%
• Lead one peer-assessed debriefing session: 5%
• Conduct a peer assessment of an emergency incident debriefing: 5%
• Assess the safety of the emergency environment: 5%
• Compare different levels of care: 15%

Emergency Healthcare Principles: 5 WIL credits, assessment results cumulatively contribute 10% towards the final component mark, and include the following assessments:

• Simulation on environmental emergencies: 20%
• Reflection: 5%
• Mini case presentation: 25%

Gas Exchange: WIL, assessment results cumulatively contribute 20% towards the final component mark and include the following assessments:

• MCAS: 15%.
• Peer teaching and assessment of the indications and utility of airway adjuncts: 5%.
• Online analysis, interpretation, and conclusion: 15 CXRs: 5%
• Online analysis, interpretation, and conclusion: 15 ABGs: 5%
• Patient simulation assessment: 20%

Perfusion: WIL, assessment results cumulatively contribute 20% towards the final component mark and include the following assessments:

• Formulate a care plan: 10%
• Online quiz: Diagnostic test analysis: 5%
• Management of code red simultaneous evaluation: 10%
• Online analysis, interpretation, and conclusion: 15 ECGs: 5%
• MCAS of a code red emergency patient: 20%

Neurological integration: WIL, assessment results cumulatively contribute 15% towards the final component mark and include the following assessments:

• Perform a neurological exam on 2 code red patients: 5%
• Brainstorming to solve a problem: 5%
• Online analysis, interpretation, and conclusion: 10 C-spine x-rays: 5%
• Mini bedside assessment of a code red emergency patient: 20%
• Simulation assessment: 15%

Biochemical Balance: WIL, assessment results cumulatively contribute 15% towards the final component mark and include the following assessments:

• MCAS: 20%
• Simulation evaluation: 15%
• Online quiz: calculation of medication rate and dose: 5%
• Online quiz: calculation of intravenous fluid rate and dose: 5%
• Online quiz: interpretation of arterial blood gas for Acid-Base balance: 5%

Motility and Tissue integrity: WIL assessment results cumulatively contribute 10% towards the final component mark, and include the following assessments:

• Create a logbook, analysis and report: 10%
• Online analysis, interpretation, and conclusion: 10 pelvic x-rays: 5%
• Mini bedside assessment of a code red emergency patient: 20%
• Simulation assessment: 15%

Inflammation: WIL, assessment results cumulatively contribute 5% towards the final component mark and include the following:

• MCAS: 25%
• Simulation assessment: 25%

High-stakes continuous assessments (called formative assessments)

• Viva Voce in simulation: 10%
• Viva Voce retrospective code red case: 20%
• Viva Voce simulation: 30%
• Viva Voce shift leading: 40%

To pass the qualification, learners must show proof of a completed clinical portfolio of evidence and current ACLS certification.