Postgraduate Diploma in Orthopaedic Nursing

Purpose

The purpose of the Postgraduate Diploma in Orthopaedic Nursing is to strengthen and deepen the clinical nurse specialist's knowledge and advanced skills with expertise in orthopaedic nursing. It will enable the orthopaedic nurse specialists to undertake advanced reflection and development by means of engaging in research which is evidence-based in their field. Furthermore, this qualification will enable a link between professional practice accountabilities, competence, research, leadership and quality patient care.

The qualification will develop orthopaedic nurse specialists who will use expert knowledge and advanced skills to provide care for patients with neuro-musculoskeletal trauma (injuries) and disorders and their families across the health-illness continuum in various orthopaedic health care settings throughout the lifespan.

This qualification will enable the orthopaedic nurse specialist to play a significant role in preventive, promotive, curative and rehabilitative care of the orthopaedic patients at primary, secondary and tertiary levels of health care. This qualification will provide extensive theoretical engagement, sound clinical judgement, intellectual independence and the ability to apply knowledge to a range of contexts to render professional and comprehensive evidence-based orthopaedic nursing care. It promotes professional development and advances the practice of orthopaedic nursing speciality for the nursing profession while producing the competent orthopaedic nurse specialist to meet the needs of the individuals and communities, displaying commitment to continuing education, excellent practice and dedication to providing the highest quality care to orthopaedic patients.

The qualification will produce orthopaedic nurse specialists equipped with research and leadership skills, clinical judgement and advocacy skills which promote reflective practice in orthopaedic nursing in accordance with the relevant ethical and legal frameworks through collaboration with the inter- and intra-professional orthopaedic team. The qualification has a comprehensive health care focus and incorporates competencies for the prevention, promotion, management and rehabilitation of orthopaedic patients in all orthopaedic care settings and the community. The curriculum is competency-based and has a strong component of work-integrated learning. Learners will be placed in a variety of clinical learning sites throughout the qualification, as part of work-integrated learning to facilitate integration of theory to practice and development of the required competencies in line with the requirements of the relevant statutory professional bodies.

The qualification is structured will equip the learners with the competencies in various skills as well as optimal hands-on learning opportunities to assist in the provision of orthopaedic nursing care in various healthcare settings to address the needs of patients with neuro-musculoskeletal problems in the country within the orthopaedic nurse specialists' scope of practice. The qualification utilises learner-centred approaches in learning and teaching, aimed at providing the orthopaedic specialist nurse with a wide range of skills, knowledge and attitudes which will promote the culture of lifelong learning and continuing professional development.

Rationale

The qualification is aligned to the Higher Education Qualification Sub-Framework (HEQSF), new nursing qualifications and the new scope of practice for an Orthopaedic nurse specialist as envisaged by the South African Nursing Council (SANC) promulgated by the Nursing Act no.33 of 2005. This qualification will enable the Orthopaedic Nurse Specialist to function as a leader who is clinically focused, service-oriented, autonomous, innovative and able to render comprehensive, scientific Orthopaedic nursing care, as determined by the appropriate legislative framework.

According to the South African Nursing Council Statistics (2020), there were 1151 registered orthopaedic nurse specialists, implying that the country with a high burden of disease does not have sufficiently trained orthopaedic nurses. The World Health Organisation Global Health Estimates (2019) depict that accident injuries are the 6th cause of death and disability internationally. This portrays the increase in the number of accidents resulting in musculoskeletal injuries, which in turn demands an increase in the number of orthopaedic nurse specialists needed to provide specialised care and rehabilitation for these patients. The Department of Health followed the World Health Organisation's Strategy on the implementation of Community-Based Rehabilitation for Disabled People of South Africa.

The Orthopaedic Research Collaboration for Africa Investigators (2020) revealed that South Africa has the highest gunshot-related mortality rate in the world (86%), representing a significant burden of disease in the South African health system, with KwaZulu-Natal having 21% in two weeks. Most of these gunshot injuries occur in the neuro-musculoskeletal system, which requires specialised care rendered by orthopaedic nurse specialists.

According to the Health Human Resource Strategy (2020), South Africa has an 80% nurse-based health system. Given the central role nurses play in the South African health system, the qualification will address human resources needs and skills gaps in line with the current burden of disease. Furthermore, Sustainable Development Goal 3C, which is aimed at improving service quality and addressing the challenges in the health system, will be met

The qualification will produce a nurse specialist who is competent to serve in a dynamic health care system. This requires health care professionals who can promote and provide excellence in care for people with neuro-musculoskeletal injuries and diseases and their families through a comprehensive, inter-professional, evidence-based approach to orthopaedic practice.

On successful completion of this qualification, the nurse will be registered with the South African Nursing Council as an Orthopaedic nurse specialist and will be internationally recognised for practice to meet the needs of the global health economy. The Orthopaedic nursing curriculum is primary health care-based, includes both theory and practice elements, with a minimum of 40% theory and a minimum of 60% practice.

Recognition of Prior Learning (RPL)

RPL for access

The is no RPL for this Postgraduate Diploma in Orthopaedic Nursing for access.

The South African Nursing Circular 14 of 2022 illustrates the SANC's disagreement with the Council on Higher Education's Communique 10 of 2022.

The SANC's Education and Training Guideline for Postgraduate Diplomas is specific about the minimum requirements for admission: proof of current registration as a Professional Nurse and Midwife (NQF level 8) or a General Nurse with a Midwifery qualification (NQF level 7). Considering this requirement, it is challenging for a higher education institution to accommodate applicants via the route of RPL for access. Applicants must meet the minimum entry requirements that form the basis upon which to build into the specialisation.

Entry Requirements

The minimum entry requirement for this qualification is

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

Or

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

Or

• Bachelor of Nursing in Education and Administration, NQF Level 7.

And

• Registration with SANC as a Professional Nurse or General Nurse with Midwifery.

This qualification consists of the following compulsory modules at National Qualifications Framework Level 8, totalling 128 credits.

Compulsory Modules, NQF Level 8, 128 Credits

• Foundations of Orthopaedic Nursing, 16 Credits.
• Orthopaedic Trauma Nursing, 24 Credits.
• Orthopaedic Nursing Practice 1, 24 Credits.
• Orthopaedic Nursing Practice 2, 24 Credits.
• Nursing Research, 16 Credits
• Clinical Nurse Specialist Practice, 16 Credits.

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

Associated Assessment Criteria for Exit Level Outcome 1

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

Associated Assessment Criteria for Exit Level Outcome 2

• Engage in orthopaedic specialist practice and apply the process of evidence-based practice.
• Apply evidence-based specialist practice, taking into consideration the appropriate methodology of gathering evidence for practice.
• Critically analyse various levels of evidence in the evidence-based practice.

Associated Assessment Criteria for Exit Level Outcome 3

• Apply leadership skills appropriate to 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, 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, 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

• Explain the purpose of the advocacy role for a nurse specialist practice.
• Apply advocacy principles to ensure safe and quality care in various healthcare settings.
• Use appropriate communication skills and channels in facilitating advocacy.

Associated Assessment Criteria for Exit Level Outcome 5

• Analyse levels and/ or classification of the respective specialist orthopaedic units.
• Commission tasks considering the burden of diseases and priority services as determined by current events.
• Participate in the evaluation of the existing specialised orthopaedic unit and apply guidelines for provisioning a specialist unit.
• Engage in planning and commissioning of the role and responsibilities in this task within the inter- and intra-professional team.

Associated Assessment Criteria for Exit Level Outcome 6

• Conduct a literature review using appropriate search engines and databases to inform orthopaedic evidence-based practice.
• Use appropriate methods to generate evidence for utilisation in specialist practice (e.g. research, systematic reviews, etc.).
• Use the peer-reviewed journals for sharing of evidence.
• Base the specialised orthopaedic practice activities 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 specialised orthopaedic practice for utilisation and storage in accordance with the set standards.
• Utilise comprehensive data, information and emerging evidence pertinent to the orthopaedic specialist practice.
• Identify and diagnose problems and opportunities for improvement based on gathered and critically analysed assessment data from the patients/clients, families, communities, including current scientific evidence.
• Respect for intellectual property by documenting without plagiarism.

Associated Assessment Criteria for Exit Level Outcome 8

• Discuss the position of orthopaedic nursing specialist service within the health care system.
• Apply the full range of services within the orthopaedic nurse specialist practice.
• Render specialised orthopaedic nursing care and integrate promotive, preventive, curative, rehabilitative and palliative care in a healthcare continuum.
• Apply knowledge, skill and attitudes to render orthopaedic nursing specialist care in accordance with national and international standards and protocols of the orthopaedic nursing specialist field.
• Formulate orthopaedic nursing diagnoses that are congruent with the patient's/client's clinical manifestations/data, and are 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 individualised orthopaedic nursing interventions considering patients'/clients' needs, values, beliefs, preferences, culture and contextual variables, for example, disease burden, health risks, national priorities, etc.
• Plan orthopaedic nursing interventions based on formulated nursing diagnoses, and application of orthopaedic specialised knowledge and skills (competencies), including advanced pharmacology in collaboration with the inter- and intra-professional team.
• Timeously, accurately, safely and effectively implement planned orthopaedic nursing interventions in accordance with set evidence-based standards, guidelines, protocols, algorithms, etc., specific for the specialist field.
• Plan health care interventions in collaboration with the patient or client, family and relevant members of the health care team.
• Include the preparation of patients/clients, families, and nurses in the lower-level care for continued care in the hospital and community in the nursing interventions in accordance with the health status and health literacy of the patient/client.
• Timeously and effectively document and revise nursing interventions based on critical analysis of the monitoring and evaluation data and reach a sound clinical judgement.

Associated Assessment Criteria for Exit Level Outcome 9

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

Associated Assessment Criteria for Exit Level Outcome 10

• Identify, share and collaboratively solve problems, informed decisions and sound clinical judgement in the orthopaedic nursing specialist area.
• Appropriately and timeously consult and provide holistic care in a healthcare continuum through awareness of one's competence.
• Appropriately and timeously carry out patient referral as dictated by the patient's condition and in accordance with the referral guidelines.
• Recognise the members of the team in the inter- and intra-professional team participation.

Associated Assessment Criteria for Exit Level Outcome 11

• Discuss the steps in and or levels of the development of policies, programmes and projects.
• Explain own role and responsibilities within the inter- and intra-professional policy/project team in project and policy development.
• Advocate for the orthopaedic nursing profession and patients/clients, families and communities in the specialised orthopaedic nursing area in policy development, programme and project development.
• 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 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 change processes in the implementation of the new policies, protocols and guidelines to the specialised orthopaedic nursing area.
• Develop collaboratively, revise policies, protocols and guidelines at appropriate intervals and approve as per the institutional policy for the specialist area.

INTEGRATED ASSESSMENT

The assessment strategy comprises formal and informal assessments. Informal assessments are used during facilitation and as part of the consolidation of what the learners may have learnt on their own. They provide an opportunity for lecturers to establish learners' understanding of the subject matter. This includes the following strategies, which serve as both teaching and assessment strategies:

• Flipped class: Learners will be given content to read on their own, and in class, reflect on what they have learnt. Questions on the application of the theory will be asked to determine their level of understanding.
• Group discussions: Small group discussions will provide an opportunity for the lecturer to observe a few learners discussing a specific assigned topic in a limited period, thus determining the depth of their understanding of the subject matter.
• Presentations: Learners will be asked to do presentations in class on selected topics. These may be done in summary form. The lecturer will be able to gauge the learners' level of understanding.
• Jigsaw: Learners will be divided into groups to discuss to learn about a topic in class. Individual learners will be assigned specific focal areas in each group. Each learner will have an opportunity to present to their group, and consolidation in each group is done before further presentation to the class. This will provide an opportunity for a lecturer to determine the learners' ability to participate in a group and their appreciation of collaboration and cooperation.
• Simulation: It will provide an opportunity for learners to see the relevance of their learning in the practice environment, while it provides the lecturer opportunity to observe learners perform in a controlled, safe environment. This is more relevant in orthopaedic nursing as orthopaedic treatment modalities need to be practised before exposure to real-life situations, as they may result in irreversible complications that may cause physical and psychological disabilities.
• Demonstrations: Learners will demonstrate specific skills in both simulated and real-life situations during supervision. Lecturers will have the opportunity to observe learner performance individually or in a group.
• Role Play: This assessment approach in orthopaedic nursing provides an opportunity for learners to practice skills such as health education and counselling of Orthopaedic patients. Lecturers observe learners' level of clinical competence and provide feedback for improvement where necessary.
• Debate: Debates will be applied wherein learners are given a topic to debate about, especially application of legal prescripts in practice, e.g. The Compensation for Occupational Injuries and Disease Act no 130 (COIDA) of 1993, Road Accident Fund Act no 56 of 1996 & Employment Equity Act no 55 of 1998.

The lecturer can be a moderator while observing the level of understanding on the learners' part.

Formal assessments will be in the form of formative and summative assessments. Formal assessments will determine learners' progression between semesters and completion of training.

Formative Assessments: Formative assessments will contribute 30% towards the final mark in the module. The assessment content will be commensurate with the percentage contributed by the formal assessment.

Theory: The following strategies will be used to assess learners' cognitive grasp of the subject matter: written tests, assignments, case studies, projects (quality improvement, community projects) and clinical assessments in real-life situations. Integration of theory and practice approach will be applied in all assessments; however, theory and work-integrated learning will be assessed separately, and marks will be published separately. Formative clinical assessments are conducted in the clinical areas, and their average percentage contributes 30% towards the final clinical nursing result.

Summative assessments: Summative assessments will be conducted at the end of each semester. They contribute 70% towards the final examination result. Theory examination papers will be set for each module. Work-integrated learning will be assessed in the form of a comprehensive clinical examination in each semester. This comprehensive examination will embrace all the modules which have a clinical component in a semester. Work-integrated learning is assessed separately and must be passed for the learner to complete training.