Postgraduate Diploma in Primary Care Nursing

Purpose

The public and private sectors need qualified specialists to improve health at the community and family levels. The purpose of the qualification is to offer a professional nursing specialization that combines conceptual and contextual knowledge, skill, and applied competencies. The nature of health care requires nurses with a broad spectrum of competencies in clinical care and practice, leadership, and management in healthcare services. The qualification equips the Specialist Practitioner with the specialist knowledge and skills in providing advanced clinical care to individuals of all ages and families in a primary care setting.

The qualification aims to produce high-quality graduates, who can function with advanced intellectual and practical competencies, in complex specialized areas of nursing practice. They will be skilled in providing evidence-based care together with other team members. The Nurse Specialist works within a multidisciplinary team in units of a range of settings such as public and private clinics, primary health care centres, prisons, hospitals, Non-Governmental Organizations, and in private partnerships such as Pharmacy Clinics. The focus of the qualification will be to extend theory and its application in practice. Typical learning pathways will need to include case studies and practice-based project work. Learning in a clinical context, under the supervision of an advanced health specialist such as a clinical nurse practitioner will guide practice towards higher skills levels with progress and performance.

On completion, qualifying learners will be able to

• Manage nursing care in a health care facility by implementing effective ethical and legal frameworks, practices, and standards within an inter-professional team.
• Identify the legislative and ethical systems relevant to the practice of nursing by applying critical thinking skills.
• Apply research principles to provide evidence-based solutions for nursing and midwifery practises.
• Provide maternal and child health care to promote the health of families, women and children throughout the procreation cycle and lifespan.
• Provide health care responsive to the needs of consumers based on legislation and policies applicable to disciplinary theories, methods and techniques of the nursing profession.
• Take responsibility for health care in any context through critically evaluating own life-long professional development and the development of peers.

The qualification provides a career path for professional nurses nationally to specialise in Primary Care Nursing and add to their depth of knowledge, skills attitudes, and values. The sector needs qualified specialists both to improve practice and to train other nurses. Achievement of the qualification will provide the learner with direct access to a Master`s Degree to further develop their professional pathway. The nursing career context is an ever-changing one. The qualification will offer nurses registered with the South African Nursing Council (SANC), as a Professional Nurse and Midwife (PN and RM) the opportunity to specialise in Primary Care Nursing practice.

Rationale

According to the Nurses Education Training and Practice (2012/13-2016/17), South Africa faces a quadruple burden of disease consisting of HIV/AIDS, communicable diseases, non-communicable diseases and a high rate of violence/injury resulting in high levels of morbidity and mortality. This burden of disease presents a huge challenge to the nursing fraternity as South Africa's primary healthcare service is mostly nurse-based. There is currently a mismatch between the current healthcare needs of the population and the number of professional nurses in Primary Health Nursing being trained at Higher Education Institutions. South Africa is one of the countries that participate in the endeavour to reach the United Nations Sustainable Development Goals (SDGs). Nurses in general, specifically the Professional Health Care Nurses and Midwives play an important role in achieving these goals.

The demand far exceeds the number of nurses that should be trained per year. This is specifically due to the primary health care approach in the health care system of South Africa, expecting all nurses to be cognisant of this area of the approach. If a balance between supply and demand is not kept, service delivery will be compromised, with the implications of higher levels of patient morbidity and mortality with regards to respiratory diseases, infections, communicable and non-communicable diseases, violence, injuries and TB/HIV/AIDS, (Bradshaw, 2010) and the SDGs will not be attained by 2030. The qualification is designed to address the shortage of Primary Health Care Nurses.

The National Department of Health has highlighted the need for the training of additional nurses by focussing on the training of Primary Health Care (PHC) personnel, The importance of this category of specialist is recognised as the Primary Care practitioner forms part of the District Clinical Specialists team within the re-engineered PHC approach. The qualification is essential for the provision of an effective, universal, accessible, and quality healthcare system in South Africa since PHC is the nucleus of the National Health System and essential in the National Insurance Plan (Matsotso & Fryatt, 2013; National Health Plan for South Africa, 1994).

The PHC specialist will serve the Government's vision for 2010-2014, namely, to achieve a "long and healthy life for all South Africans". Further, the Negotiated Service Delivery Agreement (NSDA), signed in October 2010, requires the health sector to achieve four key outputs, namely:

• Increasing life expectancy.
• Decreasing maternal and child mortality rates.
• Combating HIV and AIDS and Tuberculosis.
• Strengthening health systems effectiveness.

The qualification will therefore serve the country through providing relevant qualified healthcare practitioners within a new and growing speciality in South Africa. The qualification is responsive to changes, including demographics, technology, health care systems, globalization, and evolving health care/social issues that impact Primary Care practices. The qualification is aimed at providing the learner with in-depth knowledge and expertise, clinical competencies, skills and management to function independently, interdependently and effectively in a Primary Health Care setting within a District Health System and ethical and legal framework.

There is a strong movement towards preventative and promotive care in South Africa, as a large portion of the population is dependent on public services to receive health care. At all levels of care, the Primary Health Nurse will be the nursing team leader and she will be supported by the middle-level workers (the Staff Nurse and Auxiliary Nurse). The aim is to prepare nurses to demonstrate clinical judgement and critical thinking skills with a focus on a primary health care approach. Graduates will be able to provide primary and preventative health care with an appreciation for and the necessary reference to the curative and rehabilitative component in rendering health care for communities. The qualification will therefore enable qualifying learners to register with SANC as Primary care Nurse Specialist. Qualifying learners will be able to work as primary Care Nurse specialists in primary, secondary, and tertiary healthcare settings, function as an expert within the District Clinical Specialist Teams and render advanced primary care nursing care in specialised units where primary care patients are treated.

Recognition of Prior Learning (RPL)

Recognition of Prior Learning (RPL) is a process of identifying the knowledge and skills of an applicant against the admission requirements of a qualification and/or for credits against a part thereof. The process involves the identification, mediation, assessment and acknowledgement of knowledge and skills obtained through informal, non-formal and/ or formal learning.

RPL for access

• RPL will be applied for gaining access to the qualification, gaining credits and/or advanced standing as described in institutional guidelines.
• Learners may provide evidence of prior learning to comply with the requirements of the qualification.
• The Department of Nursing has, in its rules, admission via RPL, which allows potential learners RPL for advanced standing to enable them to access the qualification.

RPL for exemption from modules

RPL allows potential learners who have other primary care nursing qualifications to apply for exemption of modules for credits towards the qualification.

• Learners must develop a Portfolio of Evidence (PoE) using the ten competencies of the National Qualification Framework (NQF) (HEQSF) at Level 7. The PoE will determine whether this learner show the competence to complete a Postgraduate Diploma in Primary Care Nursing qualification in mind.

RPL for credits

• Through RPL they may receive credit towards the qualification after undergoing assessment through portfolios or other forms of appropriate evidence and/or challenge examinations.
• Credit shall be appropriate to the context in which it is awarded and accepted.

Entry Requirements

The minimum entry requirement for this qualification is

• Bachelor of Arts: Nursing Science, NQF Level 7.

Or

• Bachelor of Nursing Science, NQF Level 7.

Or

• Advanced Diploma in Midwifery, NQF Level 7.

And

- Current registration with the SANC as a

> Professional Nurse.

> Midwife.

And

• Placement in a clinical practice setting relevant to Primary Care Nursing.

Or

• One-year clinical experience as a Professional Nurse after completing the required years of community service.

This qualification consists of the following compulsory and/or elective modules at National Qualifications Framework Level 8 totalling 120 Credits.

Compulsory Modules, Level 8,120 Credits

• Fundamentals In Research, 8 Credits.
• Professional Practice, 8 Credits.
• Research Methodology, 8 Credits.
• Research Practicum, 16 Credits.
• Professional Development, 8 Credits.
• Management And Leadership, 8 Credits.
• Dimensions Of Primary Health Care Practice, 16 Credits.
• Theory Of Primary Clinical Skills, 16 Credits.
• Pharmacology And Community Orientation, 16 Credits.
• Clinical Skills Application And Portfolio Development, 16 Credits.

1. Demonstrate knowledge of basic research methodology in the appraisal of research articles in primary care nursing.
2. Conduct primary care nursing services in a legal, ethical and professional environment resolving and reflecting on ethical dilemmas by using decision-making and moral reasoning models suitable for different ethical value systems in rendering the primary care nursing services in a variety of settings for individuals, families and communities at district, the provincial and national level within the context of national health policy and international guidelines.
3. Analyse the appropriateness of a range of research methods and approaches for investigating primary care nursing research problems to present comprehensive findings and ideas to members of the healthcare team and the public.
4. Identify and critique own learning strategies which effectively address his or her professional and ongoing learning needs and the professional and ongoing learning needs of others to demonstrate a coherent and critical understanding of the principles and theories of management and leadership within primary care nursing.
5. Apply principles of knowledge translation to promote evidence-based nursing education and improve the quality of primary care nursing.
6. Work as a specialist practitioner with other team members within the primary care setting providing comprehensive clinical care.
7. Demonstrate an informed and critical understanding of the principles, theories and emerging issues and debates in family/primary care nursing.
8. Apply specialist knowledge and skills in providing advanced clinical care to individuals of all ages, and families, in a primary care setting.

Associated Assessment Criteria for Exit Level Outcome 1

• Appraise research articles in the speciality field of nursing through the application of basic knowledge of research methodology.
• Differentiate the qualitative, quantitative, and mixed methods research design.
• Apply standards of the research process in appraising research articles.

Associated Assessment Criteria for Exit Level Outcome 2

• Identify and debate legislative and regulatory requirements for Primary Care Nursing.
• Manage professional misconduct according to institutional and legal protocol.
• Evaluate and apply decision-making and moral reasoning models to resolve ethical dilemmas within primary care nursing.
• Examine and apply advocacy principles to advocate for safe and quality care.

Associated Assessment Criteria for Exit Level Outcome 3

• Evaluate standard guidelines used in the field of primary care nursing by applying knowledge of the systematic review and guideline development process.
• Demonstrate academic writing skills in academic writing in primary care nursing.
• Use the appropriate format such as PICO in formulating research questions.
• Apply search strategies such as Boolean in searching different databases in primary care nursing.
• Evaluate speciality-based guidelines using standardized evaluation tools.

Associated Assessment Criteria for Exit Level Outcome 4

• Evaluate and apply the Primary Care Nursing principles and theories to management and leadership.
• Debate the key concepts of self-responsibility, self-ownership, self-leadership and self-development.
• Assess the degree of self-ownership in developing professionally to stay a competent practitioner.
• Develop a framework to demonstrate the process of self-development in the professional career.
• Draw and apply self-mentoring strategies to develop oneself.
• Create a plan to establish academic/professional relationships to sustain lifelong learning amongst nurses.
• Monitor own development by sing performance appraisal principles within the Primary Care Nursing context.
• Distinguish between the concept's 'mentor' and 'mentee'.
• Develop a policy for the unit/formulation in a health and/ or midwifery service, regarding a mentoring contract.
• Debate the purpose of mentorship in the nursing units.
• Explore and apply a model for implementing mentorship in a unit for novices.
• Create a positive learning climate by establishing positive relationships.

Associated Assessment Criteria for Exit Level Outcome 5

• Promote quality nursing care by implementing evidence-based practice through the knowledge translation process.
• Compare models of knowledge translation and select the most appropriate model for use in Primary Care Nursing.
• Apply knowledge translation model in a health care unity to promote evidence-based nursing in Primary Care.
• Monitor organization and performance by comparing pre-post knowledge translation data.

Associated Assessment Criteria for Exit Level Outcome 6

• Identify and evaluate individual, family and community factors that influence and threaten the health of the patient through the risk-appropriate methodology.
• Develop, implement, and evaluate risk management strategies by assessing the overall health of individuals and families.
• Facilitate and coordinate clinical care to provide leadership.

Associated Assessment Criteria for Exit Level Outcome 7

• Identify and integrate theoretical frameworks in clinical practice.
• Articulate substantial point of view regarding emerging issues and debates relevant to family nursing.
• The presentations of the learners on issues in the field reflect an understanding of the dynamic and tentative nature of specialist knowledge.
• Evaluate research findings; analyse useful new knowledge; integrate research findings into practice; interpret research, pharmacology, the pathophysiology of illnesses affecting all systems of the body; evidence-based practice.

Associated Assessment Criteria for Exit Level Outcome 8

• Conduct advanced health assessment of patients accurately (history taking, assessment, differential diagnosis).
• Individual assessment; physical; cardio-vascular; respiratory; ear, nose & throat; ophthalmic; gastrointestinal; renal; reproductive; endocrine; muscular-skeletal; abdominal; dermatology; neurological and mental health assessment.
• Conduct health assessment on a sound understanding of pathophysiology, determinants of health (social, cultural, political, economic, psycho-social, family and community dynamics), epidemiology and biostatistics.

Procedures associated with the role of a family practitioner are competently implemented. These include but are not limited to:

• Physical assessment/examination of all systems.
• Conduct/order and interpret investigations relevant for primary health care settings.
• Range: Biochemical; haematological; microbiological; pharmacological.
• Order, read and interpret x-rays and sonars.
• Perform and interpret electrocardiogram (ECG).
• Carry out emergency procedures relevant for a primary care setting.
• Range: Life support; management of ingestion of poisons and exposure to hazardous chemicals and body fluids; prophylaxis.
• The final clinical diagnosis, for health problems managed in a primary health care setting, is accurate and according to standards.
• A range of specialised care, treatment and services are provided according to established nursing standards:

> Case management.

> Health & risk surveillance.

> Teaching, counselling & advocacy.

> Communication, networking, referral and follow-up.

> Treatment adherence.