Postgraduate Diploma in Primary Care Nursing

Purpose

The purpose of the Postgraduate Diploma in Primary Care Nursing is to strengthen and deepen the learners' knowledge and expertise in primary care nursing as a speciality. It will enable the nurse specialist to undertake advanced reflection and development through a systematic survey of current thinking, practice and research methods in their field or discipline. The qualification aims to develop a nurse specialist who will use expert knowledge to enhance patient care. This includes preventing disease, injury, complications, screening, appropriate management and prompt referral of patients with specific and complex problems in all clinical settings.

The qualification will provide a high level of theoretical engagement, sound clinical judgement and intellectual independence, as well as the ability to relate knowledge to a range of contexts to render professional and competent nursing care highly skilled work. The qualification was designed to equip learners with relevant knowledge and skills combined with the required attitude and values to enter the field of nursing education as a career, either in the public or private sector. The qualification includes research and high demand on theoretical engagement as well as independent learning with the emphasis on higher-order meta-cognitive skills such as analysis, synthesis and evaluation. Reflective practice and critical thinking will be developed across the qualification.

The primary care nurse is found in primary care settings and services, which include but are not limited to, all clinics, primary health care centres, prisons, hospital "out patients' department", ward-based, non-governmental organizations, private partners e.g. pharmacy setting. The context will include all kinds of health establishments. The primary care nurse gets patients/clients directly from the communities. She/he refers to a general medical practitioner, medical specialist, other nurse specialist and any level of health establishment.

The competencies of this nurse specialist overlap with some of the competencies of other nursing specialisation areas. The competency domains for the primary care nurse specialist include the following:

• Professional, Ethical and Legal Practice.
• Clinical Practice.
• Personal Development and Quality of Care.
• Management and leadership.
• Research.

Rationale

This qualification addresses the human resource development needs of the country for specialist nurses. A specialist nurse/midwife practitioner is a registered nurse/midwife clinician who has acquired the expert clinical knowledge and skills that include complex decision-making abilities and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which she/he has the credentials to practice. This qualification will enable the learner to function as a leader who is clinically focused, service-orientated; and autonomous, innovative nurse specialist who can render comprehensive, scientific nursing care, as determined by the appropriate legislative framework. Learners will function within the approved scope of practice as specified by the South African Nursing Council (SANC), complemented by the policies and procedures of the institution of employment.

Primary care nurse specialists are uniquely positioned to ensure the success of the re-engineering of the Primary Health Care strategy of the Department of Health since they are equipped to be specialists in the delivery of primary health care. In certain circumstances, they perform the functions normally performed by medical practitioners and pharmacists.

The qualification is aligned to the exit-level outcomes and competencies published by the South African Nursing Council and places a unique emphasis on person-centred care, ethics, leadership and evidence-based practice. In April 2011, the Department of Health held a nursing summit on the theme "Reconstruction and Revitalising the Nursing Profession". Six core areas were identified as priorities during this summit which included nursing education and training; leadership, governance, policy and legislation; ethical matters as well as nursing practice.

Learners gain an understanding of the dynamic field of primary health care and its challenges. Learners learn to cope with the demands of providing clinical person-centred care, respond to unfamiliar situations/events and develop professionally towards being confident, patient advocates and assertive in a multi-disciplinary team context. Learners apply their knowledge of evidence-based practice and health services management to continuously improve the quality of patient care and patient outcomes.

Recognition of Prior Learning (RPL)

Due to the variety of qualifications that precedes the new SANC requirements, recognition for prior learning is of great importance in this field of study. The qualification adheres to the Institution regulations and the faculty-specific procedures for RPL.

Provision is made for prior learning to be recognised to gain access to the qualification, obtain the qualification in part through the RPL process, or obtain advanced standing. RPL applicants should demonstrate competence in respect of certain specified knowledge, skills and/or attitudes about this qualification.

The specific form of assessment to determine the extent of recognition of prior learning will depend on evidence produced by each learner. In case of the learner not being able to produce a certificate of credits gained, the assessment should at least involve the presentation of a portfolio of evidence as proof of competence in the curriculum components the learner is claiming credits for.

All applications will be judged against the conditions and rules as specified in the RPL regulations of this institution. This includes the following:

• The qualification in its entirety cannot be obtained by way of RPL. A maximum of 50% credits of a completed qualification may be transferred to another qualification.
• Admission of learners through the RPL route should not constitute more than 10% of the student intake for the qualification.

A further consideration is that there is a big change in the needs of the community that nurses have to serve; this partly explains the "migration" amongst practitioners to other qualifications. Nurses are finding that their existing qualifications do not meet emerging needs or requirements, and they move to another to meet those needs.

Existing registered nurses, as well as professional nurses qualified under the new professional degree, may wish to obtain this qualification.

In addition, there are gaps between old qualifications and the requirements of the new scope of practice, and a consequent need to upgrade qualifications. RPL is seen as vitally important in every case to give recognition to learning already in place, make sense of the plethora of different levels and standards in the field, and provide a means for all to gain access to, and progress within, a common learning pathway for the profession

Entry Requirements

The minimum entry requirement for this qualification is

• Bachelor of Nursing, NQF Level 7, granting access to a Postgraduate Diploma.

Or

• Advanced Diploma in Midwifery, NQF Level 7.

Or

• Relevant Qualification in the Related Field, NQF Level 7, granting access to a Postgraduate Diploma.

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

Compulsory Modules,128 Credits

• Praxis of Specialist Practice, 8 Credits.
• Applied Research, 8 Credits.
• Leadership and Development in Specialist Practice, 8 Credits.
• Evidence-based nursing and midwifery practice, 8 Credits.
• Pharmacology, 15 Credits.
• Principles and Processes of Primary Care, 15 Credits.
• Health Assessment, Diagnosis, Treatment and Care, 25 Credits.
• Specialist Primary Care Practice, 33 Credits.
• Praxis of Specialist Practice, 8 Credits.

1. Practice within the ethical- legal parameters of the nursing profession in a Primary Health Care setting, and resolve professional-ethical dilemmas by using decision-making and moral reasoning models.
2. Apply basic knowledge and principles of research methodology in the field of primary care nursing.
3. Demonstrate advanced knowledge of primary health care in a variety of health care settings, to promote health outcomes.
4. Render and coordinate comprehensive, multi-sectoral and people-centred primary health care in a variety of healthcare settings, to promote health outcomes.
5. Apply scientific knowledge and principles of the systematic review and guideline development process, to evaluate and review the standard of guidelines used in primary care practice.
6. Evaluate and apply principles of evidence-based care to ensure quality primary care practice.
7. Implement strategies to develop self and peers by promoting self-directedness through a process of precepting and mentoring.
8. Manage primary care nursing services by implementing effective medico-legal norms, practices and standards within an inter-professional team.

Associated Assessment Criteria for Exit Level Outcome 1

• Use critical decision-making and moral reasoning models to guide clinical practice and resolve professional-ethical dilemmas within primary health care nursing practice.
• Apply the relevant latest legislation, policies, protocols, regulations, and guidelines regarding primary health care nursing in various healthcare settings.
• Apply the professional ethical and legal frameworks to guide the practice of the Primary Care Nurse Specialist.
• Practice and facilitate advocacy in the patient's best interest.
• Interpret and apply ethical codes, professional accountability, responsibility, confidentiality and standards for the practice of primary care nursing consistently and correctly.

Associated Assessment Criteria for Exit Level Outcome 2

• Apply academic writing skills in the research report.
• Appraise research articles in the field of primary care nursing through the application of basic knowledge of research methodology.
• Differentiate between qualitative, quantitative, and mixed-methods research designs accurately.
• Integrate evidence-based practice of research findings for safe, effective and efficient practice.

Associated Assessment Criteria for Exit Level Outcome 3

• Promote health outcomes through the demonstration of knowledge of primary health care nursing in a variety of healthcare settings.
• Interpret and use epidemiological data pertaining to primary care nursing to plan a community awareness programme/campaign.
• Identify, debate, recommend and communicate legislation, policies and guidelines relevant to the primary care of clients to authorities.
• Identify strategies to ensure that the human rights of clients in primary care are respected.
• Use best available evidence to plan a healthy environment for the primary care of clients throughout the levels of healthcare.
• Discuss and explore triage principles within a primary care setting.
• Use legislation on drug prescriptions, storage, disposal and dispensing to evaluate current practice.
• Debate, recommend and communicate the influence of the social, political, cultural and economic developments within the country on the provision of primary care to authorities, with the ultimate goal of improving primary care nursing.
• Explore and debate suitable injury or condition-specific assessment techniques for primary care of clients to improve health outcomes.
• Use biomedical, pharmacology and psychosocial sciences to explain the interpretation of health assessment findings and management of conditions affecting primary care clients.
• Interpret and explain subjective and objective assessments to make a nursing diagnosis.
• Develop and apply comprehensive individual, people-centred inter-professional treatment plans based on assessment findings and standardised national and contextually appropriate guidelines.
• Establish care priorities to the primary care clients' problems and severity, with due consideration of system and practice challenges.
• Monitor and interpret the health status of primary care clients continuously and plan actions within an inter-professional team.
• Explain and debate the rationale and safety measures of technology used in assessing and treating primary care clients.
• Explore and debate care pathways and the referral system.
• Use legislative and care standards to evaluate records of primary care clients.
• Evaluate the accuracy of data pertaining to primary care.

Associated Assessment Criteria for Exit Level Outcome 4

• Promote health outcomes through the rendering and coordination of specialist primary care nursing in a variety of healthcare settings.
• Conduct community awareness campaigns based on epidemiological data pertaining to primary care.
• Respect the human rights of primary care clients.
• Create and sustain a healthy environment for primary care patients of different ages across the health continuum, which is based on the best available evidence and resources.
• Perform subjective and objective assessment competently, to make a nursing diagnosis.
• Apply clinical reasoning by considering social determinants of health and all relevant clinical findings to make a diagnosis.
• Execute and coordinate comprehensive, individual, people-centred treatment plans competently within a multi-sectoral team.
• Apply triage principles to clients awaiting treatment at a primary care facility.
• Conduct comprehensive assessment of clients competently.
• Calculate severity of a primary care client's injury or condition according to standardised tools, and execute optimal interventions within the limitations of the system and practice.
• Monitor and interpret the health status of the primary care clients continuously and act on within the inter-professional team.
• Use technology appropriately and safely in ways that facilitate diagnosing and treatment of primary care clients.
• Evaluate and apply principles of health dialogue to negotiate the treatment plan with the clients and family.
• Apply care pathways and the referral system appropriately.
• Audit records of primary care clients to evaluate the standard of care.
• Capture and utilise primary health data (statistics) accurately to improve primary health care nursing practice.

Associated Assessment Criteria for Exit Level Outcome 5

• Evaluate and report current evidence-based guidelines used in primary care practice at predestined times to improve health care;
• Apply academic and professional writing skills in reports and guidelines.
• Formulate research questions according to the patient/population, intervention, comparison and outcomes (PICO) and other formats.
• Appraise evidence-based practice, theories or models on primary care and adopt best practice guidelines to improve health care service delivery.
• Search databases by using Boolean and other information search strategies.

Associated Assessment Criteria for Exit Level Outcome 6

• Promote quality of patient care and safety by implementing evidence-based practice.
• Use systematic reviews to improve client experience and outcomes in primary care practice.
• Perform quality audits aimed at improving patient services at predetermined times.
• Monitor patient outcomes, including quality patient care and safety continuously.

Associated Assessment Criteria for Exit Level Outcome 7

• Apply precepting and mentoring processes to develop self and peers.
• Develop thinking and reasoning processes of self and others through facilitation of learning.
• Apply learning theories in own development and the development of others.
• Create a positive learning environment by supporting peers and novices.
• Establish and use academic networks to sustain personal development.

Associated Assessment Criteria for Exit Level Outcome 8

• Manage primary care services according to medico-legal norms, practices and standards within an inter-professional team.
• Evaluate and apply leadership styles within the primary care inter-professional team.
• Create and document shared decision-making opportunities regarding primary care services.
• Access and use benchmarks and best practices to develop indicators for quality and cost-effectiveness in primary care nursing.
• Mobilise and utilise resources to optimise primary care nursing.
• Examine and apply reporting pathways optimally.
• Analyse and optimise referral and care pathways.
• Coordinate the activities of the inter-professional team within primary care nursing well.
• Gather and use morbidity and mortality data of primary care nursing to guide decision making.