Postgraduate Diploma in Perioperative Nursing

Purpose

The purpose of the Postgraduate Diploma in Perioperative Nursing is to prepare a perioperative nurse specialist with speciality-focused skills and knowledge to function at an advanced perioperative level within the perioperative environment. The perioperative nurse specialist will utilise advanced knowledge and skills in this diverse and complex specialist field to provide care in the preoperative, intraoperative and postoperative stages of the patient presenting for surgery.

The advanced knowledge and skills will allow the perioperative nurse specialist to engage in effective ethical decision-making with respect to perioperative practice areas and in prioritising emergency situations. This specialist will be able to recognise and act upon laws relating to the professional role and professional code of conduct, implement and reinforce identified strategies and protocols to reduce legal implications and ensure implementation of standards to strengthen safety and continuity of care.

This qualification aims to produce a graduate who can provide evidence-based care whilst showing support of the surgical patient, family and community throughout the perioperative period within the professional, legal and ethical framework.

The perioperative nurse specialist will be able to liaise with the intra-professional team, including collaborating with other stakeholders postoperatively, thus demonstrating critical decision-making skills and effective coordination to ensure high-quality patient care. This qualification will further equip the perioperative nurse specialist with teaching, learning and management skills at all levels of practice.

Learners will be placed in a variety of clinical learning sites throughout the qualification to facilitate the integration of theory to practice and the development of the required competencies in line with the requirements of the relevant statutory professional bodies. This qualification will enable the perioperative nurse specialist to function at an advanced clinical level within all areas of perioperative nursing. The qualification will equip learners with the competencies in various skills as well as optimal hands-on learning opportunities to assist in the provision of nursing care in various healthcare settings to address the health needs of the country within the perioperative nurse's scope of practice.

The perioperative nurse specialist will develop analytical techniques and problem-solving skills that can be applied across perioperative care and transferred to related areas such as critical care. In addition, they will be able to evaluate evidence, arguments and assumptions, reaching sound judgements and effectively communicating within their sphere of perioperative practice.

Rationale

The Postgraduate Diploma in Perioperative Nursing is aligned to the Higher Education Qualification Sub-framework (HEQSF), South African Nursing Council (SANC's) new nursing qualifications framework for Postgraduate Diploma in Perioperative Nursing.

This qualification is intended to prepare the qualifying graduate as a perioperative nurse specialist who will be able to meet the service delivery needs of the country. Graduates will be competent in responding to priority health care needs and emerging issues in the population across life by providing holistic health care that is ethical, safe and evidence-informed to positively impact the health and quality of life of individuals, families, groups and communities.

A perioperative nurse specialist will benefit a transforming healthcare system by providing highly skilled perioperative services in this area of specialisation. The graduate will be able to function as a leader who is clinically focused, service-oriented, autonomous and innovative. This specialist will be able to render comprehensive, scientific perioperative nursing care, as determined by the appropriate legislative framework. The qualification will contribute to the production of perioperative nurse specialists who are able to comprehensively and conscientiously apply knowledge to practice in a highly technical and complex perioperative environment, providing patient care within a large interdisciplinary team whose combined goal is patient safety.

The perioperative nurse specialist introduces patients undergoing surgery from traditional boundaries of the operating theatre to include broader perioperative environments such as ambulatory settings and endoscopic units. The perioperative nurse specialist will contribute to a safe patient journey and better patient outcomes not only through their role as patient advocates but also through the application of specialist knowledge and skills, which is underpinned by a culturally safe and ethically caring approach.

This qualification will provide the South African community with significant numbers of nurse specialists in the perioperative Nursing Management field so that nursing-related issues requiring advanced knowledge and skills, professional, ethical and legal intervention are facilitated and promoted in the perioperative environment. According to the position statement on the allocation of non-specialised nurses in specialised units by SANC signed on the 25/05/2021, all specialised units must be managed and led by a qualified nurse specialist, which therefore warrants a need for specialised perioperative nurse training.

The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output. Health facilities were required to reduce non-essential activities, including many surgical services. A retrospective study conducted in six South African government hospitals in the Western Cape, South Africa, concluded that the COVID-19 pandemic had created large backlogs of elective operations. Another study done at a tertiary hospital in KwaZulu-Natal indicated that theatre caseload decreased by 30% from January to April 2020. The resulting theatre case deficit was 1,260 cases. There is a need to streamline the reintroduction of full surgical healthcare services and personnel. The impact of COVID-19, which has led to a gross backlog in surgical operations due to COVID-19 restrictions, further strengthens the need for specialised perioperative nurses to assist with these operations to address the emotional trauma suffered by the patients due to the cancellation of surgical operations and the increased financial costs incurred by the hospitals.

Recognition of Prior Learning (RPL)

There is no RPL for access to the Postgraduate Diploma in Perioperative Nursing. 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 Critical Care Nursing, NQF Level 7.

Or

• Advanced Diploma in Preoperative, Operating Room and Surgical Nursing, NQF Level 7.

Or

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

Or

• Bachelor of Nursing, NQF level 7.

Or

• Bachelor of Nursing Science, NQF Level 7.

And

• Registered Professional Nurse and Midwife with SANC

And

• A minimum of at least two years' experience as a nurse, including community service experience.

And

• A minimum of one year of clinical experience in the Operating Theatre environment.

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 Perioperative Practice, 16 Credits
• Perioperative Nursing Practice 1, 24 Credits
• Perioperative Nursing Practice 2, 24 Credits
• Anaesthesia Care, 24 Credits
• Nursing Research, 16 Credits
• Contemporary Issues in Perioperative Nursing, 8 Credits
• Clinical Nurse Specialist Practice, 16 Credits

. Practice and facilitate perioperative specialist nursing within ethical-legal parameters of the profession.

1. Apply the knowledge of and facilitate evidence-based practice in perioperative nursing to solve contextual problems and develop policies and guidelines.
2. Demonstrate the ability to appraise and develop self, peers and perioperative nurse specialist learners by facilitating self-directedness/leadership and lifelong learning to maintain competence.
3. Demonstrate the ability to facilitate advocacy for the profession and provision of specialist professional support for personnel, patients or clients, families and communities.
4. Demonstrate the ability to engage in planning, commissioning and managing a perioperative specialist unit, an educational entity or a health service.
5. Demonstrate the ability to engage in scholarly activities to inform evidence-based perioperative nursing practice, education or management.
6. Demonstrate the ability to utilise, manage and communicate data to support decision-making and research.
7. Demonstrate the ability to render and co-ordinate patient-centred perioperative specialist nursing within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences, including advanced pharmacology.
8. Demonstrate the ability to mobilise appropriate resources to implement standards of practice relevant to the operating theatre to ensure quality patient care and safety.
9. Demonstrate the ability to collaborate within the inter-professional team by engaging in health dialogue, shared leadership, decision making and sound clinical judgement.
10. Demonstrate the ability to participate in the design, development, implementation and evaluation of nursing policies, programmes and projects at the provincial or national level.
11. Demonstrate the ability to develop and implement institutional policies, protocols, and guidelines in the operating theatre, 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 perioperative nursing.
• Apply critical decision-making and moral reasoning models and principles to make clinical judgements and resolve ethical dilemmas within perioperative nursing practice.
• Demonstrate accountability for own professional judgement, actions, outcomes of perioperative nursing provided and continued competence.
• Integrate and apply relevant current legislation, policies, regulations and guidelines pertaining to perioperative nursing.
• Accurately, comprehensively and timeously document all care activities, considering the legal requirements for record keeping.
• Manage professional misconduct according to institutional protocols and legal framework.

Associated Assessment Criteria for Exit Level Outcome 2

• Discuss the process of evidence-based practice in perioperative nursing.
• Apply evidence-based perioperative nursing considering appropriate methodology of gathering evidence for practice, systematic or scoping reviews, appraisal articles, practice-based research and publication.
• Critically analyse the various levels of evidence using evidence-based practice.

Associated Assessment Criteria for Exit Level Outcome 3

• Effectively facilitate continuous professional development (CPD) for self, others and for lifelong learning.
• Create a positive learning climate in the workplace through the process of mentorship, preceptorship, supervision and performance appraisal.
• Describe the purpose of performance management processes and development systems in performance appraisal.
• Utilise feedback gained from self-reflection, peers, learners and management to improve effectiveness in the perioperative specialist role.
• Identify various risk factors for stress and burnout at the workplace and strategies used to care for oneself and peers/employees/learners.

Associated Assessment Criteria for Exit Level Outcome 4

• Discuss the purpose of the advocacy role for the perioperative nurse specialist.
• Apply advocacy principles to advocate for safe and quality care in the perioperative care setting.
• Use appropriate communication skills and channels in advocacy.
• Lobby and/or participate in interest groups to influence legislation and policy affecting the profession.

Associated Assessment Criteria for Exit Level Outcome 5

• Explain the levels and/or classification of the specialised perioperative nursing units.
• Commission considering the burden of diseases and priority services as determined by current events.
• Apply guidelines for the provisioning of perioperative specialist units in the evaluation of the existing specialised perioperative nursing units.
• Discuss the roles and responsibilities of specialised perioperative nursing in planning and commissioning within the inter-professional team.

Associated Assessment Criteria for Exit Level Outcome 6

• Practice in perioperative care demonstrates knowledge of appropriate search engines and databases for review of literature to inform evidence-based practice.
• Use appropriate methods to generate evidence for utilisation in perioperative care.
• Demonstrate awareness of peer-reviewed journals used for sharing evidence.
• Base activities on scientifically proven evidence in the perioperative care settings.
• Actively participate in inter-professional dialogues /debates/discourses in quality improvements.

Associated Assessment Criteria for Exit Level Outcome 7

• Document all data /information gathered in the context of the perioperative nursing care practice for utilisation and storage in accordance with set standards.
• Utilise comprehensive data information and emerging evidence pertinent to perioperative nursing care.
• Identify and diagnose problems and critically analyse opportunities for improvement of assessment data from critically ill patients.
• Respect intellectual property and minimise plagiarism in the documentation.

Associated Assessment Criteria for Exit Level Outcome 8

• Explore the position of specialised perioperative nursing service within the health care system.
• Discuss the full range of services within the specialised perioperative practice.
• Render and integrate promotive, preventive, curative and rehabilitative care in the specialised perioperative nursing healthcare continuum.
• Render specialist perioperative nursing care in accordance with institutional, national and international standards and protocols of the perioperative nursing field.
• Formulate nursing diagnoses 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 perioperative nursing interventions considering patients'/clients' needs, values, beliefs, preferences, culture and contextual variables, for example, disease burden, health risks, national priorities, etc.
• Plan perioperative nursing 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 perioperative interventions timeously, accurately, safely and effectively in accordance with set evidence-based standards, guidelines, protocols, algorithms, etc., specific for the perioperative field.
• Plan perioperative 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 in nursing interventions for continued care in the hospital and community in accordance with the health status and health literacy of the patient/client.
• Document and revise timeously and effectively perioperative nursing interventions based on critical analysis, monitoring and evaluation of data in order to reach a clinical judgement.

Associated Assessment Criteria for Exit Level Outcome 9

• Identify the infrastructure and equipment needed in the perioperative environment.
• Render care, operate and monitor the equipment used in the specialised perioperative environment.
• Employ adequate, well-maintained and up-to-date equipment.
• Assign staff to nursing care considering the Perioperative Nursing specialist's qualification and competencies, experience, standard nurse patient for the perioperative nursing specialisation ratios, job description and skill mix.

Associated Assessment Criteria for Exit Level Outcome 10

• Identify, share, and collaboratively solve practical problems informed by decisions and sound clinical judgment in the specialised perioperative nursing 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 referrals 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 and levels of the development of policies, programmes and projects.
• Examine own role and responsibilities within inter- and intra-professional teams in project and policy development.
• Advocate for the perioperative nursing profession and patients/clients, families and communities in the specialised perioperative nursing area in policy development, programme and project development.
• Apply appropriate communication techniques such as negotiation, bargaining, assertiveness, persuasion, etc., in project development.
• Provide adequate feedback on time 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 process of development of policies, standards, protocols and guidelines.
• Use the appropriate methods in the process of development and evaluation, or testing of guidelines and protocols.
• Implement new policies, protocols and guidelines in the perioperative specialist area to demonstrate understanding and application of the change process.
• Develop and collaboratively revise policies, protocols and guidelines at appropriate intervals and approve as per the institutional policy for the perioperative specialist area.

INTEGRATED ASSESSMENT

The assessment strategy for the Postgraduate Diploma in Perioperative Nursing 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:

Lectures - The lecture method will be used minimally to present common and complex content, allowing interactive learning. It will be used to introduce and clarify information in foundational modules. The lecture method promotes deductive reasoning. The lecturer-learners' interaction will enable the learners to apply critical thinking and problem-solving skills. Modes of delivery include face-to-face contact, formal lectures, provocative lectures, interactive lectures, PowerPoint presentations, smart boards, charts and models, Videos and textbooks.

Case Studies - Case studies will be used in case presentations based on module outcomes and will be allocated to learners to research, prepare and present. Case-based teaching is used to promote integration of theory and practice. It helps learners in developing skills to collect data/history taking, data analysis, data interpretation and consolidation as well as presentation of findings when dealing with patients undergoing various types of surgery. Modes of delivery include individual and group presentations, assignments, projects and researchable cases.

Assignments - Assignments on the various drugs used in the care of patients in the perioperative setting will be allocated to groups and/or individual learners for the collection of information, consolidation, analysis and interpretation of findings and reporting.

It will enhance basic academic writing skills, teamwork, and promote contextual and inquiry-based learning.

Tutorials will be utilised to provide additional support and /or individual attention to a group of learners, which is usually a smaller group, to promote understanding of learning content.

Reflective Learning Diaries - Reflective learning diaries are logs or journals of work-based learning of what the learners have learnt, tried and critically reflected upon. The use of experiential learning diaries will promote the development of self-awareness through reflection on practice. Learners are requested to record their hands-on experiences with the various operative procedures, and this provides evidence of acquired skills over time.

Web-based learning will allow the learners to access information at their own pace/time, which promotes self-directed learning and peer and facilitator support. Methods include an online literature search.

Flipped class - Learners will be given content to read on their own, and in class, reflect on what they have learned. Questions on the application of the theory will be asked to determine their level of understanding.

Group discussions - Group discussions involve the allocation of tasks to groups of learners to research, prepare and present. It will provide an opportunity for the lecturer to observe a few learners discussing a specific assigned topic in a limited period of time, thus determining the depth of their understanding of the subject matter. It promotes collaborative and cooperative learning (teamwork), communication skills, Peer-to-peer feedback and develops self-awareness. It uses evidence-based practice examples and online literature searches to facilitate discussions.

Presentations - Learners will be asked to do presentations in class on selected topics such as operative procedures. 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 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 is an attempt to replicate nearly all aspects of the clinical situation to make it more understandable. It will provide an opportunity for the learners to see the relevance of their learning in the practice environment, while it provides the lecturer to observe learners perform in a controlled, safe environment. This is more relevant in perioperative nursing as learners need to practice operating theatre skills before exposure to real-life situations.

Demonstrations - Learners will demonstrate specific skills in both simulated and real-life situations during supervision, such as the surgical scrubbing technique. The lecturer will have the opportunity to observe learners' performance as an individual or in a group.

Role Play- This assessment approach in perioperative nursing provides an opportunity for learners to practice skills such as roles of the scrub nurse, anaesthetic nurse and circulating nurse within the operating theatre as well as the role of a nurse in the preoperative holding area and Postanaesthetic Care Unit (PACU). Lecturers observe learners' level of clinical competence and provide feedback for improvement where necessary.

Debate - Involves learners in expressing their opinions from two competing perspectives with the goal of contradicting each other's arguments. An opportunity for a decision may be given after opposing views are presented in alternating statements. Debates will be applied wherein learners are given a topic to debate about, especially application of legal prescripts in practice, e.g., the Choice on Termination of Pregnancy Act 92 of 1996 as amended and its impact on the physical, psychological and social health of the patient and reproductive health care services.

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.
• Written tests, assignments, case studies, projects (quality improvement, community projects), and clinical assessments in real-life situations will be used to assess theory modules.
• Integration of theory and practice approach will be applied in all assessments; however, theory and work-integrated learning will be assessed separately and marks published separately.
• Formative clinical assessments are conducted in the clinical areas; 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.
• WIL 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.
• WIL is assessed separately and must be passed for the learners to complete training.