Postgraduate Diploma in Mental Health Nursing

Purpose

The purpose of this qualification is to strengthen and deepen the learners' knowledge and expertise in mental health nursing as a speciality. It will enable the Nurse Specialist to undertake advanced reflection and development through a systematic survey of current thinking, practice and research methods in their field or discipline. The qualification aims to develop a Nurse Specialist who will use expert knowledge to enhance mental health care. This includes the development of in-depth knowledge of, and therapeutic skills for, the diagnosis, treatment, care and management of individuals with a mental disorder at a primary, secondary and tertiary care level, with specific emphasis on consultation-liaison skills.

The qualification will provide a high level of theoretical engagement, sound clinical judgement and intellectual independence, as well as the ability to relate knowledge to a range of contexts to render professional, competent and highly skilled work. The qualification is designed to equip learners with relevant knowledge and skills combined with the required attitude and values to enter the field of mental health nursing as a career, either in the public or private sector. The qualification includes research and high demand for theoretical engagement as well as independent learning with the emphasis on higher-order meta-cognitive skills such as analysis, synthesis and evaluation. Reflective practice and critical thinking will be developed across all modules as much as possible.

The Mental Health Nurse Specialist who has completed this qualification will be able to

• Provide clinical leadership in the care of patient/s throughout the lifespan in a specialist nursing field.
• Provide comprehensive evidence-based nursing care including technology for patients in a specialist nursing field on primary, secondary and tertiary levels of care.
• Practice within an ethical-legal framework including equity and justice to ensure accountability.
• Evaluate health care outcomes and make innovative suggestions to improve quality care and safety.
• Provide professional support for personnel, patients, families and groups to promote independence and behavioural change, including the prevention of mental health illness, promotion of mental health care and treatment to rehabilitation, using recovery supportive approaches.
• Explore and improve current practices to meet the changing needs of patients and communities.
• Make recommendations to improve the cost-effectiveness of care.
• Demonstrate accountability and moral reasoning for independent clinical decisions made regarding patient care.
• Participate in research activities such as fieldwork and publication of clinical findings.
• Collaborate with multi-disciplinary team members, inclusive of policymakers, the mental health user, the family and community stakeholders (including traditional leaders), and refer patients to relevant organizations/services.

Specialist nurses or midwives exercise person-centred practice by assimilating their values, behaviours, discipline knowledge and clinical skill through integrating the six intrinsic roles:

• Intrinsic Role: Communicator - As communicators, nurses or midwives in specialist practice form and facilitate effective, dynamic relationships with people, families and communities to gather and share essential information that enables holistic caring practice.
• Intrinsic Role: Collaborator - As collaborators, nurses or midwives in specialist practice work effectively within, between and across teams to provide safe, quality person-centred care.
• Intrinsic Role: Leader - As leaders, nurses or midwives in specialist practice engage in contemporary, sustainable and resource-sensitive caring practice to influence the healthcare and/or other relevant systems.
• Intrinsic Role: Advocate - As health advocates, nurses or midwives in specialist practice use their discipline knowledge, skill and influence in interactions to advance the health and well-being of people, families and communities.
• Intrinsic Role: Scholar - As scholars, nurses or midwives in specialist practice foster good caring practice through their valuing critical engagement, life-long learning, and contributing to knowledge development, translation and evaluation.
• Intrinsic Role: Professional - As professionals, nurses and midwives in specialist practice demonstrate commitment to the health and well-being of people, families and communities through ethical practice, accountability to the profession and society, profession-led regulation, and self-possession.

Rationale

This qualification addresses the human resource development needs of the country for specialist nurses. A specialist nurse/midwife practitioner is a registered nurse/midwife clinician who has acquired the expert clinical knowledge and skills that include complex decision-making abilities and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which she/he has the credentials to practice. This qualification will enable the qualifying learner to function as a leader who is clinically focused, service-orientated, autonomous and innovative. The nurse specialist can render comprehensive and, evidence-based nursing care within the appropriate legislative framework.

Learners will function within the approved scope of practice as specified by the South African Nursing Council (SANC), complemented by the policies and procedures of the institution of employment. The context will include all kinds of health establishments. Mental Health Nursing is found in primary care settings/services, which include but are not limited to, all clinics, primary health care centres, prisons, hospital "Outpatients' Department", ward-based, Non-Governmental Organizations and-, private partners. The Mental Health Nurse receives patients/clients directly from the communities and makes referrals to a psychiatrist practitioner, other multi-disciplinary members and any level of health establishment.

The qualification is aligned to the exit-level outcomes and competencies published by the South African Nursing Council and places a unique emphasis on person-centred care, ethics, leadership and evidence-based practice. In April 2011, the Department of Health held a nursing summit on the theme "Reconstruction and Revitalizing the Nursing Profession". Six core areas were identified as priorities during this summit which included nursing education and training; leadership, governance, policy and legislation; ethical matters as well as nursing practice.

The competencies of this nurse specialist overlap with some of the competencies of other nursing specialisations. The competency domains for the Mental Health Nurse Specialist include the following:

• Professional, Ethical and Legal Practice.
• Care Provision and Management.
• Personal and Quality of Care.
• Management and leadership.
• Research.

The competencies will be based on

• specialised mental and biopsychosocial health theoretical frameworks and current evidence-based information and practices.
• a commitment to culturally sensitive, human rights, person-centred approaches.
• the inclusion of mental health across all levels of care, from promotion to rehabilitation, and across the lifespan.
• focuses on community, family and individual.
• located international guidelines and legislation in South Africa.

Typical learners will receive one-year study leave from the Department of Health to complete the qualification since clinical placement for learning in accredited facilities is a requirement. This includes learners from different educational backgrounds. Learners gain an understanding of the dynamic field of mental health nursing and its challenges. They learn to cope with the demands of providing clinical person-centred care, respond to unfamiliar situations/events and develop professionally towards being confident, patient advocates and assertive in a multi-disciplinary team context. They apply their knowledge of evidence-based practice and health services management to continuously improve the quality of patient care and patient outcomes.

This qualification will provide qualifying learners with the opportunity to access a Master's degree.

Recognition of Prior Learning (RPL)

Due to the variety of qualifications that preceded the new SANC requirements, recognition of prior learning is of great importance in this field of study.

Provision is made for prior learning to be recognised to gain access to the qualification, obtain the qualification in part through the Recognition of Prior Learning (RPL) process, or obtain advanced standing in the prescribed learning programme.

All learners who wish to enrol must submit a portfolio of evidence. RPL candidates should demonstrate competence in specified knowledge, skills and/or attitudes pertaining to this qualification. RPL for an exemption will be considered for the core (cross-cutting) modules.

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 non-formal and/or informal learning to cope with the qualification expectations should they be allowed entrance into the qualification.

RPL for exemption of modules

• Learners may apply for RPL to be exempted for 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 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

• A Bachelor's Degree in Nursing, NQF Level 8,

Or

• A Diploma in Nursing (four years) or equivalent nursing qualification, NQF Level 7.

And

• Registration with the South African Nursing Council as a professional nurse and midwife.

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

• Praxis of Specialist Practice, 8 Credits.
• Applied Research, 8 Credits.
• Leadership and Development in Specialist Practice, 8 Credits.
• Evidence-based Nursing and Midwifery Practice, 8 Credits.
• Principles and Processes in Mental Health Nursing, 48 Credits.
• Specialist Mental Health Nursing Practice, 40 Credits.

1. Practice within the ethical-legal parameters of the nursing profession in a mental health care setting and resolve professional-ethical dilemmas by using decision-making and moral reasoning models.
2. Apply basic knowledge and principles of research methodology in the field of mental health care nursing.
3. Demonstrate advanced knowledge of mental health care in a variety of health care settings, to promote health outcomes.
4. Render and coordinate comprehensive, multi-sectoral and people-centred mental health care in a variety of healthcare settings, to promote health outcomes.
5. Apply scientific knowledge and principles of the systematic review and guideline development process, to evaluate and review the standard of guidelines used in mental health care nursing.
6. Apply principles of evidence-based care to ensure quality mental health care practice.
7. Implement strategies to develop self and peers by promoting self-directedness through a process of perception and mentoring.
8. Manage mental health nursing services by implementing effective medico-legal norms, practices and standards within an inter-professional team.

Associated Assessment Criteria for Exit Level Outcome 1

• Use critical decision-making and moral reasoning models to guide clinical practice and resolve professional-ethical dilemmas within mental health nursing practice.
• Apply the relevant latest legislation, policies, protocols, regulations, and guidelines regarding mental health in various healthcare settings.
• Adhere to the professional ethical/ legal frameworks that guide the practice of the mental health nurse specialist.
• Practice and facilitate advocacy in the patient's best interests.
• Interpret and apply ethical codes, professional accountability, responsibility, confidentiality and standards for the practice of mental health nursing consistently and correctly.

Associated Assessment Criteria for Exit Level Outcome 2

• Demonstrate academic writing skills in the research report.
• Appraise research articles in the field of mental health nursing through the application of basic knowledge of research methodology.
• Differentiate accurate qualitative, quantitative and mixed-methods research designs.
• Integrate evidence-based practice of research findings for safe, effective and efficient practice.

Associated Assessment Criteria for Exit Level Outcome 3

• Promote health outcomes through the demonstration of knowledge of mental health nursing in a variety of healthcare settings.
• Interpret and use epidemiological data pertaining to mental health nursing to plan a community awareness programme/campaign.
• Identify, debate and recommend and communicate legislation, policies and guidelines relevant to the mental health care of clients to authorities.
• Identify strategies are identified to ensure that the human rights of clients in mental health care.
• Use best available evidence to plan a healthy environment for the mental healthcare of clients throughout the levels of healthcare.
• Discuss and explore admission procedures and principles within a mental health care setting.
• Use legislation on drug prescriptions, storage, disposal and dispensing to evaluate current practice.
• Debate the influence of the social, political, cultural and economic developments within the country on the provision of mental health care, and communicate recommendations to authorities, with the ultimate goal of improving mental health care nursing.
• Utilise psychopharmacology and psychosocial sciences to explain the interpretation of health assessment findings and management of conditions affecting mental health care users.
• Interpret and explain mental status examinations to make a nursing diagnosis.
• Base comprehensive individual, people-centred inter-professional treatment plans on assessment findings and standardised national and contextually appropriate guidelines.
• Establish care priorities in relation to the mental health care users' problems and severity, with due consideration of system and practice challenges.
• Monitor, interpret and plan actions of the mental health status of mental health care users continuously within an inter-professional team.
• Explain and debate the rationale and safety measures of technology used in assessing and treating mental health care users.
• Explore and debate care pathways and the referral system.
• Use legislative and care standards to evaluate records of mental health care users.
• Evaluate the accuracy of data pertaining to mental healthcare.

Associated Assessment Criteria for Exit Level Outcome 4

• Promote health outcomes through the rendering and coordination of specialist mental healthcare nursing in a variety of healthcare settings.
• Base community awareness campaigns on epidemiological data pertaining to mental health care.
• Respect the human rights of mental health care users.
• Create and sustain a healthy environment for mental health care users of different ages across the health continuum, which is based on the best available evidence and resources.
• Perform subjective and objective assessment competently, to make a nursing diagnosis.
• Demonstrate clinical reasoning by considering social determinants of health and all relevant clinical findings to make a diagnosis.
• Execute and coordinate comprehensive, individual, people-centred treatment plans competently within a multi-sectoral team.
• Apply assessment principles to users awaiting treatment at community level care facilities.
• Conduct comprehensive assessments of users competently.
• Calculate severity of mental health user's condition according to standardised tools and execute optimal interventions within the limitations of the system and practice.
• Monitor, interpret and act on the health status of the mental health user continuously within an inter-professional team.
• Use technology appropriately and safely in ways that facilitate diagnosing and treatment of mental health care users.
• Use principles of health dialogue to negotiate the treatment plan with the mental health user and family.
• Utilise care pathways and the referral system appropriately.
• Audit records of mental health users to evaluate the standard of care.
• Capture and utilise mental health data (statistics) accurately to improve mental health care nursing practice.

Associated Assessment Criteria for Exit Level Outcome 5

• Evaluate and report current evidence-based guidelines used in mental health care practice at predestined times to improve health care.
• Demonstrate academic and professional writing skills in reports and guidelines.
• Formulate research questions according to the PICO and other formats.
• Critically appraise evidence-based practice, theories or models on mental health care and adopt best practice guidelines to improve mental health care service delivery.
• Search databases by using Boolean and other information search strategies.

Associated Assessment Criteria for Exit Level Outcome 6

• Promote quality of patient care and safety by implementing evidence-based practice.
• Use systematic reviews to improve mental health user experience and outcomes in mental health care practice.
• Perform quality audits aimed at improving mental health user services at predetermined times.
• Critique, develop and implement clinical standards for mental health care practice.
• Monitor patient outcomes, including quality patient care and safety continuously.

Associated Assessment Criteria for Exit Level Outcome 7

• Apply perception and mentoring processes to develop self and peers.
• Show activities towards enhancing Continuous Professional Development (CPD).
• Develop thinking/reasoning processes of self and others through facilitation of learning.
• Apply learning theories in own development and the development of others.
• Creative a positive learning environment by supporting peers and novices.
• Establish and use academic networks to sustain personal development.

Associated Assessment Criteria for Exit Level Outcome 8

• Manage mental health care services according to medico-legal norms, practices and standards within an inter-professional team.
• Demonstrate appropriate leadership styles within the mental health care inter-professional team.
• Create and document shared decision-making opportunities regarding mental health care services.
• Access and use benchmarks and best practices to develop indicators for quality and cost-effectiveness in mental health care nursing.
• Mobilise and utilise resources to optimise mental health care nursing.
• Utilise reporting pathways optimally.
• Analyse and optimise referral/care pathways.
• Coordinate the activities of the inter-professional team within mental health nursing effectively.
• Use morbidity and mortality data of mental health nursing to guide decision making.

Integrated Assessment

The assessment practices are aligned with the institution's policy documents, which require and provide for different kinds of assessment. Generally, a practice of integrated assessment is applied to ensure that the purpose of the qualification is achieved. This means that learners are assessed as to their ability to integrate and apply knowledge gained from one module to another during the assessment of core modules. The assessment will be an integral part of the entire teaching and learning process.

Different kinds of assessment will form part of the assessment strategy

In this qualification, two assessment systems namely, examination and flexible are used. The institution's regulations for internal and external moderation and the processing of results are followed.

Examination assessment system

Some modules in this qualification will follow the traditional examination system where a range of assessments will contribute towards a class mark for the module, which allows access to the final examination. The module is concluded with a final examination. Both the class mark and the examination contribute towards the learners' final marks in a predetermined ratio, usually 50:50.

Flexible Assessment system

Some modules will use a flexible assessment system where a range of different types of assignments and projects will contribute towards a final mark. These modules may be concluded without a final examination. These assessments will aim to provide a range of marks or grades related to a learner's performance. A mix of simulated and actual clinical practice in the appropriate care settings will provide important assessment opportunities.

Formative Assessment

The purpose of formative assessment is to provide regular feedback to the learners on their progress. Formative assessment will assist the learner in the learning process and usually will not contribute to grading and promotion. By definition formative assessment takes place during (and sometimes throughout) a course and in this sense, it may be (and often is) part of the flexible assessment:

Clinical Assessment

Work placement allows for the practice of work/professional roles and competencies to a safe level under the supervision of registered professional nurses and clinical facilitators. The required hours and nature of work-based learning are clearly stipulated by the SANC as being 720 hours of work-integrated learning (which can be work-based, clinical skills laboratory or other clinical experiences) and of which 50% must be supervised and mentored. The clinical assessments include:

• Clinical assessments of physical examination skills using checklists, work and observation sheets; peer-reviews of clinical skills are completed before formal assessment.
• Case-based integrated assessment checklists, work and observation sheets (for example in the clinical setting).
• Workbook/portfolio (practice register) to be completed as part of WIL.

Summative Assessment

The purpose of summative assessment is to evaluate a learner's performance in meeting the requirements of the module as stated, that is, a pass or fail.

In practical terms, the scope of specific assessment opportunities in this qualification will be the following

• Assignments, tests or quizzes. These could include e-assessments.
• Examination papers.
• Portfolio of evidence.
• Practical evaluations, for example, portfolios, clinical competency reviews, clinic assessments, an Objective Structured Clinical Examination (OSCE) and so forth.