Postgraduate Diploma in Orthopaedic

Purpose

The purpose of the Postgraduate Diploma in Orthopaedic Nursing qualification is to provide a career path for registered nurses who would like to focus on the area of orthopaedic specialization. The learner will be able to function as an independent practitioner, achieve personal and professional growth and gain self-actualization.

The qualification aims to produce competent, dedicated Orthopaedic Nurse specialists, leaders, and researchers who demonstrate specialized knowledge and clinical skills that will be applied in various orthopaedic settings.

The learner will be clinically focused and service-orientated, able to deliver specialized orthopaedic care, including preventive, promotive, curative, and rehabilitative care.

The competencies acquired in the qualification will enable the learner 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 orthopaedic settings, displaying the following characteristics:

• independent practitioner
• leader
• researcher
• advocacy

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

• Practice and facilitate specialised Orthopaedic Nursing within the ethical and legal parameters of the profession.
• Apply the knowledge of and facilitate evidence-based practice in specialised orthopaedic nursing care to solve contextual problems and develop policies and guidelines.
• Appraise and develop self, peers, and orthopaedic nursing students by facilitating self-directedness or leadership and lifelong learning to maintain competence.
• Facilitate advocacy for the profession and provision of specialized orthopaedic professional support for personnel, patients, families, and communities.
• Engage in planning, commissioning, and managing a specialist orthopaedic nursing unit.

Rationale

According to the World Health Organization (WHO, 2022), road accidents kill approximately 1.3 million people each year globally. Non-fatal injuries affect between 20 and 50 million more people, with many becoming disabled because of injury. Despite having approximately 60% of the world's vehicles, low- and middle-income countries account for 93% of all road fatalities primarily affecting children and young adults aged 5-29 years.

Congenital anomalies affect between 1-2% of live births, with 10% of these being upper-limb deformities. WHO has reported that congenital anomalies rank 17th in causes of disease burden. Although the aetiology of congenital anomalies is approximately 50%, they sometimes can be directly linked to genetic factors (30-40%) or environmental factors (5-10%), such as drug ingestion and certain maternal diseases during the first trimester of pregnancy.

Primary bone cancers (cancers that start in the bones) are uncommon, accounting for less than 1% of all cancers. In adults, cancers that spread to the bones from other organs (known as bone metastasis) are much more common than primary bone cancers.

In South Africa most patients who are involved in road accidents sustain musculoskeletal injuries, majority of them sustain long bone fractures. These injuries increase the workload for orthopaedic surgeons and nurse specialists who treat the majority of these clients. The province with the highest number of patients was in Gauteng, followed by KwaZulu-Natal and Eastern Cape respectively during the festive season of 2019 to 2022.

With limited numbers of Orthopods in the country, training of Orthopaedic Nurse Specialists will assist in reducing the prevalence of musculoskeletal injuries, congenital anomalies, and diseases in the Gauteng Province.

The knowledge and skills acquired by the Orthopaedic Nurse Specialist will assist the government in addressing the burden of disease through primary health and Orthopaedic care in various settings. Orthopaedic qualification is a scarce skill that increases access to the provision of quality care in low- and middle-income populations. Early diagnosis and treatment of these patients will enable them to be fully rehabilitated and contribute as meaningful members of society.

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

Two independent professional organisations exist in South Africa where voluntary membership is offered to Orthopaedic 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 Orthopaedic Nurse Specialists will operate in various orthopaedic settings. They are required to work with ill patients with specific and complex musculo-skeletal conditions and provide leadership in the health care team. They conduct the workup sessions as well as to ensure effective rehabilitation post-surgery. This nurse specialist will help to maintain the excellence of the orthopaedic 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 Trauma and Emergency Nursing, NQF Level 7.

Or

• Advanced Diploma in Occupational Health Nursing, NQF Level 7.

Or

• Advanced Diploma in Medical and Surgical Nursing Science, NQF Level 7.

Or

• Bachelor of Nursing, NQF Level 7.

And

• Proof of current SANC registration as a Professional Nurse or General Nurse with Midwifery.
• The individual must also have at least two (2) years of clinical experience post registration.

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

Compulsory Modules, NQF Level 8, 144 Credits.

• Health Service Dynamics, 6.4 Credits.
• Health Science Research, 4.8 Credits.
• Orthopaedic Nursing Specialty module 1, 18.4 Credits.
• Orthopaedic Nursing Specialty module 2, 28 Credits.
• Orthopaedic Nursing Work Integrated Learning, 86.4 Credits.

1. Practice and facilitate specialised Orthopaedic Nursing within the ethical and legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice in specialised orthopaedic nursing care to solve contextual problems and develop policies and guidelines.
3. Appraise and develop self, peers, and orthopaedic nursing students by facilitating self-directedness/leadership and lifelong learning to maintain competence.
4. Facilitate advocacy for the profession and provision of specialized orthopaedic professional support for personnel, patients, families, and communities.
5. Engage in planning, commissioning, and managing a specialist orthopaedic nursing unit.
6. Engage in scholarly activities to inform evidence-based orthopaedic nursing practice.
7. Utilise, manage and communicate data to support decision-making and research.
8. Render and coordinate patient-centred specialised orthopaedic 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 the specialised orthopaedic practice 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 orthopaedic practice at provincial or national level.
12. Develop and implement institutional policies, protocols, and guidelines in the orthopaedic specialization, utilizing the process of change management in the improvement of quality of care.

Associated Assessment Criteria for Exit Level Outcomes 1.

• Apply critical decision-making and moral reasoning models and principles to make clinical judgments and resolve ethical dilemmas within the orthopaedic nursing specialist practice.
• Account for own professional judgment, actions, and outcomes of specialist care, provided and continued competence are demonstrated.
• Identify and apply relevant, current legislation, policies, regulations, and guidelines pertaining to orthopaedic nursing specialist practice.
• Document care activities accurately, comprehensively and timeously considering the legal requirements for record keeping.
• Illustrate knowledge of the orthopaedic nursing specialist role in the management of professional misconduct and risks taking into consideration the institutional protocols, other protocols, and ethical-legal framework.

Associated Assessment Criteria for Exit Level Outcomes 2.

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

Associated Assessment Criteria for Exit Level Outcomes 3.

• Illustrate leadership skills through the application of appropriate leadership styles, principles, and theories.
• 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 and show an understanding of the purpose and processes of the Performance Management and Development System.
• Utilise feedback gained from self-reflection, peers, students, management and other relevant stakeholders to improve effectiveness in the orthopaedic specialist role.
• Illustrate an understanding of the various risk factors in the orthopaedic health care settings that impact health and wellness within the workplace and apply strategies to care for self, peers, employees, and students.

Associated Assessment Criteria for Exit Level Outcomes 4.

• Illustrate an understanding of the purpose of the advocacy role for an orthopaedic specialist practice.
• Advocate and apply principles to ensure safe and quality care in various orthopaedic healthcare settings.
• Illustrate the use of appropriate communication skills and channels in facilitating advocacy.
• Demonstrate the ability to lobby and or participate in interest groups to influence legislation and policy affecting role performance.

Associated Assessment Criteria for Exit Level Outcomes 5.

• Illustrate an understanding of levels and classification of the specialized orthopaedic units.
• Commission task taking considering the burden of diseases and priority services as determined by current events.
• Participate in the evaluation of existing specialized orthopaedic unit and demonstrate knowledge of guidelines for provisioning of such unit.
• Engage in planning and commissioning and show understanding of the role and responsibilities in this task within inter and intra-professional teams.

Associated Assessment Criteria for Exit Level Outcomes 6.

• Practice in the specialized orthopaedic practice and show knowledge of appropriate search engines and databases for review of literature to inform evidence-based practice.
• Apply appropriate orthopaedic methods to generate evidence for utilization in specialized orthopaedic practice (e.g., research, systematic reviews etc.).
• Illustrate awareness of the peer-reviewed journals and use them for sharing evidence.
• Actively participate in inter and intra-professional dialogues, debates or discourses in quality improvement.

Associated Assessment Criteria for Exit Level Outcomes 7.

• Manage all data or information gathered in the context of the specialized orthopaedic practice, for utilization and storage in accordance with the set standards.
• Identify problems, diagnoses, and opportunities for improvement that are based on gathered and critically analysed assessment data from the patients, clients, families, communities, learners or employees including current scientific evidence.
• Respect intellectual property by documenting without plagiarism.
• Manage and communicate data to support decision-making and research in the context of the specialized orthopaedic practice.

Associated Assessment Criteria for Exit Level Outcomes 8.

• Illustrate understanding of the position of specialized orthopaedic service within the health care system.
• Render specialized orthopaedic nursing care to integrate promotive, preventive, curative, and rehabilitative care in a healthcare continuum.
• Formulate orthopaedic nursing diagnoses that are congruent with the patient's clinical manifestations or data based on accurate analysis and interpretation of data obtained from scientific, laboratory, diagnostic, technological and psycho-sociocultural assessment including consultation of relevant and current literature and evidence.
• Plan orthopaedic nursing interventions that are individualized considering the patient's or client's needs, values, beliefs, preferences, culture and contextual variables, for example, disease burden, health risks, national priorities, etc.

Associated Assessment Criteria for Exit Level Outcomes 9.

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

Associated Assessment Criteria for Exit Level Outcomes 10.

• Identify and share practice problems in specialized orthopaedic nursing collaboratively and solve them by informed decisions and sound clinical judgment.
• Appraise consultation appropriately and provide timeous 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 orthopaedic patient's condition and in accordance with the referral guidelines.
• Participate in and promote the inter- and intra-professional team, that is visible and recognized by the members of the team.

Associated Assessment Criteria for Exit Level Outcomes 11.

• Participate in the development of policies, programmes, and projects and show understanding of the steps in and or levels of the development of policies, programmes, and projects.
• Participate in projects and policy development applying knowledge of own role and responsibilities within inter and intra-professional policy and project teams.
• Participate in policy development, programme and project development and apply advocacy for the orthopaedic nursing profession and patients or clients, families, and communities in the specialized orthopaedic nursing area.

Associated Assessment Criteria for Exit Level Outcomes 12.

• Illustrate an understanding of the process and steps in the 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.
• Apply the process of development and evaluation or testing of guidelines and protocols in the appropriate methods.
• Implement new policies, protocols, and guidelines to the specialized orthopaedic nursing area demonstrates understanding and application of the change process.
• Develop policies, protocols, and guidelines, collaboratively revise them at appropriate intervals and approve them as per the institutional policy for the specialized orthopaedic nursing area.