Postgraduate Diploma in Nephrology Nursing

Purpose

The purpose of the Postgraduate Diploma in Nephrology Nursing is to provide a career path for registered nurses who would like to focus on the nephrology specialization. Learners will be able to function as independent practitioners, achieve personal and professional growth and gain self-actualization.

The qualification aims to produce competent, dedicated Nephrology Nurse Specialists, leaders and researchers who demonstrate specialized knowledge and clinical skills that will be applied in various nephrology settings. The graduate will be clinically focused and service-orientated and will be able to deliver specialized nephrology care, including preventive, promotive, curative, and rehabilitative care.

The competencies acquired in the qualification will enable the graduate to apply critical and analytical thinking and clinical judgment skills to facilitate comprehensive nursing care to diverse populations within the intra and inter-professional teams in various nephrology settings, displaying the following characteristics:

• Independent practitioner.
• Leader.
• Researcher.
• Advocacy.

Rationale

Studies report that there are more than 850 million people with kidney disease globally. A disproportionate burden of this number affects people in low- and middle-income countries where access to care in public hospitals is significantly limited. A prevalence of 10.7% of Chronic Kidney Disease (CKD) is reported to be in Sub-Saharan countries. The total number of patients on renal replacement therapy as of December 2020 was 8,734, which is a prevalence of 146 per million population in South Africa. The Gauteng province, followed by Western Cape and KwaZulu-Natal are reported to have the highest number of patients with renal impairments. Whilst the prevalence of CKD is rising rapidly in low- and middle-income countries, the Covid-19 pandemic worsened the state. Mortality rates from COVID-19 approximated 20% of patients on maintenance dialysis and exceeded 20% in kidney transplant recipients. With limited numbers of nephrologists in the country, training of Nephrology Nurse Specialists will curb the burden of CKD in South Africa.

This qualification is a scarce skill qualification and on research, only two (2) institutions are accredited to offer the qualification at the postgraduate level, in the Eastern Cape and Western Cape. Only one (1) of the nine (9) public nursing colleges has expressed an interest in offering the qualification.

Transformation of nursing education in the country resulted in a decline in the number of trained Nephrology Nurse Specialists for the previous three years. This had a negative impact on the output of Specialist Nurses in general. Early diagnosis and treatment of these patients will enable them to be fully rehabilitated and contribute as meaningful members of society. Nephrology qualification is a scarce skill that increases access to the provision of quality renal nursing in low- and middle-income populations. The knowledge and skills acquired by the Nephrology Nurse Specialist will assist the government in addressing the burden of disease through primary health and kidney care approaches in various settings.

On successful completion of the qualification, the graduate will be awarded a qualification registered at NQF Level 8. According to the South African Nursing Council (SANC) Education and Training Postgraduate Diploma Guidelines (2020), the graduate shall write the licensure examination in line with the guidelines determined by the Council. On successful completion of the licensure examination, the graduate will be registered as a Nephrology Nurse Specialist with the SANC as defined by the Nursing Act 33 of 2005. The registration is renewable on an annual basis.

Three (3) independent professional organisations exist in South Africa where voluntary membership is offered to nephrology specialists/nurses to affiliate on an annual basis. The purpose of the collaboration is to broaden knowledge, skills, networking, and benchmarking for best practices, including participating in the development and revision of guidelines.

The Nephrology Nurse Specialists will operate in various nephrology units and renal transplant settings. They are required to work with ill patients with specific and complex renal conditions and provide leadership in the health care team. They conduct the workup sessions of potential organ donors and recipients of kidney transplants as well as to ensure effective rehabilitation post-surgery. This nurse specialist will help to maintain the excellence of the nephrology practice.

Recognition of Prior Learning (RPL)

The institution has an approved Recognition of Prior Learning (RPL) policy applicable to equivalent qualifications for admission into the qualification. RPL will be applied to accommodate applicants who qualify. RPL thus provides alternative access and admission to qualifications, as well as advancement within qualifications.

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 formal, non-formal and/or informal learning to cope with the qualification expectations.

RPL for exemption of modules

• Learners may apply for RPL to be exempted from 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 formal, 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

• Advanced Diploma in Critical Care Nursing, NQF Level 7

Or

• Advanced Diploma in Midwifery, NQF Level 7

Or

• Bachelor of Nursing, NQF Level 7

And

• Proof of current SANC registration as a Professional Nurse and Midwife, NQF Level 7 or General Nurse with Midwifery, NQF Level 7
• At least two (2) years' experience after registration as a Professional Nurse or General Nurse and Midwife. The two years include a year of community service.
• The candidate must have one (1) year of experience in a nephrology unit post-community service year.

This qualification consists of the following compulsory modules at NQF Level 8 totalling 144 Credits.

Compulsory modules, Level 8, 144 Credits

• Health Service Dynamics, 6 Credits.
• Health Science Research. 5 Credits.
• Comprehensive Health Assessment, 20 Credits.
• Management of Kidney Pathologies, 27 Credits.
• Nephrology Nursing Work Integrated Learning, 86 Credits.

1. Demonstrate the ability to practice and facilitate specialized nephrology nursing within the ethical-legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice in the nephrology field to solve contextual problems and develop policies and guidelines.
3. Appraise and develop self, peers, and nephrology nursing 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 professional support for personnel, patients, families, and communities.
5. Demonstrate the ability to engage in planning, commissioning, and managing nephrology units.
6. Demonstrate the ability to engage in scholarly activities to inform evidence-based practice.
7. Demonstrate the ability to utilize, manage and communicate data to support decision-making and research.
8. Render and coordinate patient-centred specialized nephrology nursing within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences including advanced pharmacology.
9. Mobilize appropriate resources to implement standards of practice relevant to nephrology nursing 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. Demonstrate the ability to participate in the design, development, implementation and evaluation of nursing policies, programmes, and projects at a provincial or national level.
12. Demonstrate the ability to develop and implement institutional policies, protocols, and guidelines in nephrology nursing, utilizing 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 in the practice of specialist nephrology nursing.
• Apply critical decision-making and moral reasoning models and principles to make clinical judgments and resolve ethical dilemmas within the nephrology nursing specialist practice.
• Become accountable for own professional judgment, actions, and outcomes of specialist care and provide continued competence.
• Identify and apply relevant current legislation, policies, regulations, and guidelines pertaining to nephrology nursing specialist practice.
• Document all care activities accurately, comprehensively, and timeously considering the legal requirements for record keeping.
• Apply knowledge of the nephrology nursing 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 the evidence-based practice process and the nephrology nursing specialist practice.
• Apply evidence-based nephrology nursing specialist practice, using the appropriate methodology of gathering evidence for practice, for example, systematic or scoping reviews, and appraisal of articles, practice based-research and publication.
• Critically analyse various levels of evidence-based practice and nephrology nursing specialist practice.

Associated Assessment Criteria for Exit Level Outcome 3

• Apply leadership skills appropriate for leadership styles, principles, and theories.
• 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 in the performance management processes and development system.
• Utilize feedback gained from self-reflection, peers, learners, management, and other relevant stakeholders to improve effectiveness in the nephrology nursing specialist role.
• Assess the impact of various risk factors on 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 and the role of advocacy in the nephrology nursing specialist practice.
• Apply advocacy principles to ensure safe and quality care in various nephrology nursing healthcare settings.
• Use the appropriate communication skills and channels in facilitating advocacy.
• Lobby and /or participate in interest groups to influence legislation and policy affecting the role performance.

Associated Assessment Criteria for Exit Level Outcome 5

• Analyse the levels and classification of the nephrology nursing specialist units.
• Commission tasks by considering the burden of diseases and priority services as determined by current events.
• Participate in the evaluation of the existing nephrology nursing specialist unit and establish the guidelines for provisioning a specialist unit.
• Discuss the role and responsibilities in planning and commissioning tasks within inter and intra-professional teams.

Associated Assessment Criteria for Exit Level Outcome 6

• Practice in the respective specialized nephrology nursing health setting.
• Apply appropriate methods to generate evidence for utilization in specialist nephrology nursing practice (e.g. research, systematic reviews etc.).
• Conduct the peer-reviewed journals and use them for sharing of evidence.
• Base activities in the specialist nephrology nursing 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 nephrology nursing practice, for utilization and storage in accordance with the set standards.
• Utilize comprehensive data, information and emerging evidence pertinent to the respective specialized nephrology nursing practice.
• Base the 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.
• Respect intellectual property and observe plagiarism.

Associated Assessment Criteria for Exit Level Outcome 8

• Evaluate the position of specialized nephrology nursing service within the health care system.
• Discuss the full range of services within the specialized nephrology nursing area of practice.
• Render integrated promotive, preventive, curative, and rehabilitative care in specialized nephrology nursing care.
• Render specialist nephrology nursing care in accordance with national and international standards and protocols of nephrology nursing specialist field.
• Formulate nephrology nursing diagnoses in line with the patient's/client's clinical manifestations/data and accurate analysis and interpretation of data obtained from scientific, laboratory, diagnostic, technological and psycho-sociocultural assessment including consultation of relevant/current literature/evidence.
• Plan individualized nephrology nursing interventions considering patients/client's needs, values, beliefs, preferences, culture, and contextual variables, for example, disease burden, health risks, national priorities, etc.
• Plan nephrology 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 the planned nephrology nursing interventions timeously, accurately, safely, and effectively in accordance with set evidenced-based standards, guidelines, protocols, algorithms etc. specific to the nephrology nursing specialist field.
• Plan the health care interventions in collaboration with the patient or client, family, and relevant members of the health care team.
• Prepare the 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 Nephrology Nursing interventions timeously and effectively based on critical analysis of the monitoring and evaluation of data and reaching a sound clinical judgement.

Associated Assessment Criteria for Exit Level Outcome 9

• Identify the infrastructure and equipment needed in the Nephrology Nursing specialization units.
• Operate and monitor equipment to render care in the specialized nephrology nursing area of practice.
• Employ sound asset management principles to ensure appropriate, adequate, well-maintained, and up-to-date equipment.
• Assign staff to nurse care considering the Nephrology Nursing Specialist's qualification and competencies, experience, standard nurse-patient ratios for the area of nephrology nursing specialization, job description and skill mix.

Associated Assessment Criteria for Exit Level Outcome 10

• Identify, share, and collaboratively solve practice problems in the specialized nephrology nursing area by informed decisions and sound clinical judgment.
• Consult and provide appropriately and timeously holistic care in a healthcare continuum through awareness of one's competence.
• Appropriately and timeously carry out patient referrals as dictated by the patient's condition and in accordance with the referral guidelines.
• Participate in the inter- and intra-professional team, visible and recognized by the members of the team.

Associated Assessment Criteria for Exit Level Outcome 11

• Discuss the steps in the development of policies, programmes, and projects.
• Explore own role and responsibilities within inter and intra-professional policy/project team in project and policy development.
• Participate in advocacy for the nursing profession and patients/clients, families, and communities in the specialized nephrology nursing area.
• Include appropriate communication (negotiation, bargaining, assertiveness, persuasion, etc) in the project and policy development.
• Provide timely and adequate feedback to relevant stakeholders as necessary.

Associated Assessment Criteria for Exit Level Outcome 12

• Examine the process and steps of development of policies, standards, guidelines, and protocols.
• Involve relevant and pre-determined stakeholders in the process of development of policies, standards, protocols, and guidelines.
• Apply the appropriate methods in the development process and evaluation or testing of guidelines and protocols used.
• Implement the new policies, protocols and guidelines to the specialized nephrology nursing area and apply the change process.
• Collaboratively revise developed policies, protocols and guidelines at appropriate intervals and approve as per the institutional policy for the specialized nephrology nursing area.

INTEGRATED ASSESSMENT

The qualification will assess competencies through integrated assessments for both theory and Work Integrated Learning (WIL). The qualification provides for both a formative and summative assessment. The formative assessment focuses not only on theoretical knowledge but also on the integration of knowledge and competencies during practical examination sessions that include clinical cases Learners will undertake summative assessments at the end of the qualification. The integrated assessment is structured according to modules as follows. Assessment is structured according to modules.

Health Science Research

Continuous Formative Assessment

• Test 1
• Research Proposal Assignment

Summative assessment

• Written examination

Work Integrated Learning

• Portfolio of evidence.
• Final submission of EBP poster.

Final Assessment

• Written examination (Theory).
• Evidence-based poster presentation.

Health Service Dynamics

Continuous Formative Assessment

• Test 1.
• Group Assignment 1.

Work Integrated Learning (WIL)

• Group assignment - Situational analysis.
• Individual assignment - skills development audit.
• Group assignment - Conducting a meeting.

Summative assessment

• Written Assessment (theory).
• Portfolio of Evidence (WIL).

Comprehensive Health Assessment

Continuous Formative Assessment

• Test 1.
• Assignment 1.
• Portfolio of evidence.

Summative assessment

• Written Assessment (Theory).

Management Of Kidney Pathology

Continuous Formative Assessment

• Test 1.
• Test 2.
• Assignment.
• Portfolio of evidence.

Summative assessment

• Written Assessment (Theory).

Nephrology Nursing Work Integrated Learning

Formative 1.

• Comprehensive patient assessment and connection of the patient on the haemo-dialysis machine using percutaneous catheters.

Formative 2.

• Comprehensive patient assessment and connection of the patient on the haemo-dialysis machine using a fistula/graft.
• Clinical workbook.
• Case presentation.
• Development of a tool.
• Calculation of paediatric ultrafiltration goal.

Final Summative Assessment

• Comprehensive patient assessment and connection of the patient on the haemo-dialysis machine using a fistula/graft.