Postgraduate Diploma in Primary Care Nursing

Purpose

The Postgraduate Diploma in Primary Care Nursing qualification will offer a wide range of transferable skills for application in other professions, disciplines, and general life, which include the capacity to assess, develop, implement, and evaluate health and other policies.

The learner will develop the ability to plan, commission and manage projects of a varied nature in the communities. They will also develop the abilities that will enable them to participate in interprofessional team activities to advocate for evidence-based care in the communities.

The needs of the client will be met through a holistic approach by addressing the physical, psychological, and social dimensions of the healthcare user within the public and private healthcare domain. Furthermore, on the completion of this qualification, learners will be able to progress in the marketplace with advanced knowledge, skills, and specific competencies in primary care.

This qualification will strengthen learners' competencies in primary care which will improve or advance the quality of nursing care and advance nursing knowledge and skills to address the health needs of the community and clients.

The learner will learn skills that will enable them to

• Plan and assist with lifestyle adjustments in consultation with the patient according to the patient's specific health care needs.
• Conducts a physical assessment, diagnoses illnesses, prescribes treatment, provides direct care to health-care consumers, and refers for further treatment as necessary.
• Provide direct care to patients with all types of illnesses and ailments, offering the first level of health care in the community and referring them where needed.

A qualified learner will be able to

• Practice as a competent, independent, critical thinker to provide scientific, safe comprehensive quality nursing care. The aim is to promote healing, prevent complications and alleviate suffering based on acquired knowledge, skills, and competencies.
• Practices as an independent and autonomous primary care nursing specialist.
• Provide effective, universal, accessible, and quality primary health care in South Africa.
• Utilise specialised judgment and skills during the conduction of a physical assessment of a client.
• Interrogate multiple sources of knowledge (pharmacology, anatomy and physiology, pathophysiology) to conclude a diagnosis and initiate treatment.
• Uphold the image of nursing through the application of an ethical, legal, and professional framework in primary care nursing.
• Participate in setting the standards for clinical practice for primary care nursing.
• Apply evidence-based practice to keep updated and skilled in the management of primary care patients.
• Establish a research culture that will lead to evidence-based and reflective practice as well as lead and manage self and others within the interprofessional team.

Ultimately, the Postgraduate Diploma in Primary Care Nursing strives to produce competent, service-driven primary care nurses, who understand and value the practice of culturally competent care and will be able to effect positive changes in in the communities as primary care nurses.

Rationale

The rationale behind the qualification is to develop a specialist nurse practitioner with advanced knowledge and expert clinical skills in line with the National and Provincial Healthcare Plans and Sustainable Development Goals as guided by the World Health Organisation (WHO). This will promote the health status of the South African population; and alleviate the lack of skills and practitioners to address the quadruple burden of disease in the healthcare system.

This qualification will also increase the number of qualified nurses who could practice within a specialised field in hospitals, clinics, industries, and communities in both public and private sectors.

Nursing specialisations are a sought-after direct articulation from the undergraduate nursing programs to the postgraduate diploma and offer a career path according to the National Scarce Skills list. The ever-increasing demand for applicants requires flexibility in terms of the offering of the program.

As Primary Health Care (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 postgraduate Primary Care Nurse will be able to function independently in the absence or scarcity of a medical practitioner and/or pharmacist (SANC Competencies, May 2014). This Postgraduate Diploma in Primary Care Nursing will provide health care to patients to an extent that the majority of the population will not need to consult with a medical officer. (SANC Competencies, May 2014; National Health Plan, 1994)

The importance of this category of specialist is recognized as the postgraduate diploma in Primary Care Nursing forms part of the District Clinical Specialists team within the re-engineered PHC approach (HRH Strategy for the Health Sector 2012/13 - 2016/17).

According to the Western Cape Persal training needs analyses (WCDoH persal 15.07.18), there are 1090 posts on Persal for a Postgraduate Diploma in Primary Care Nursing. Of these posts, 259 are currently vacant. A further indication of the training need is that 162 of these specialists are over the age of 55 years and may leave the service at any time.

The qualification will therefore serve the country by providing relevant qualified healthcare practitioners within a new and growing speciality in South Africa.

LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING

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

• Bachelor of Nursing, NQF level 7.

Or

• Bachelor of Nursing Science in Education, Management and Community, NQF Level 7

Or

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

And

Proof of registration as a Registered Professional Nurse with SANC.

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

Compulsory modules, Level 8, 120 Credits.

• Nursing research and professional ethics, 12 Credits.
• Leadership and management in advanced nursing practice, 12 Credits.
• Primary Care Dynamics, 28 Credits.
• Primary Care: Adult, 24 Credits.
• Primary Care: Child, 24 Credits.
• Pharmacology for Primary Care Nursing, 20 Credit.

1. Practice and facilitate primary care nursing, nursing education or health services management within the ethical-legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice, nursing education or management in the primary care nursing field to solve contextual problems and develop policies and guidelines.
3. Engage in planning, commissioning, and managing a primary care nursing unit, an educational entity, or a health service.
4. Engage in scholarly activities to inform evidence-based practice, education, or management related to primary care nursing.
5. Utilize, manage, and communicate data to support decision-making and research in primary care nursing.
6. Render and co-ordinate patient-centred primary nursing care within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences including advanced pharmacology.
7. Mobilize appropriate resources to implement standards of practice relevant to primary nursing care, to ensure quality patient care and safety.
8. Develop and implement institutional policies, protocols, and guidelines in primary care nursing, utilising the process of change management in the improvement of quality of care.
9. Facilitate advocacy for the profession and provision of primary care nursing professional support for personnel, patients, families, and communities.
10. Appraises and develops self, peers, and primary care nursing learners by facilitating self-directedness/leadership and lifelong learning to maintain competence
11. Collaborate within the inter-professional team by engaging in health dialogue, shared leadership, decision-making and sound clinical judgment related to primary care nursing.
12. Participate in the design, development, implementation and evaluation of primary care nursing policies, programmes, and projects at provincial or national level.

Associated Assessment Criteria for Exit Level Outcomes 1.

• Manage ethical dilemmas in primary care nursing within the ethical-legal parameters of the profession.
• Apply ethical theory, principles, and moral decision-making and reasoning skills in the holistic care of the patient and their family members/carers in primary care nursing.
• Manage moral distress in primary care nursing in the interprofessional team.
• Apply knowledge to transfer embedded accountability in learners in the primary care nursing field.
• Empower primary care nurses to manage moral distress.
• Apply ethics and ethical frameworks to guide decision-making in primary care nursing practice.
• Conduct annual patient satisfaction surveys by measuring cultural competence in primary nursing care.
• Direct ethically sound practices specifically related to prescribing and evaluating of clients' conditions in primary care nursing.
• Apply ethical principles, SANC regulations and primary care policies and procedures when providing health care to children younger than 5 years and children up to the age of 12 years.

Associated Assessment Criteria for Exit Level Outcomes 2.

• Utilise the research process in evidence-based primary care nursing research.
• Relate to relevant international, national, and provincial guidelines to enhance evidence-based primary care nursing.
• Explore how research is used as evidence guiding the practice of primary care nursing.
• Reflect and use research literature as evidence for primary care nursing practice.
• Determine and prioritise the health needs of the individual, family, and community according to national, provincial and district health indicators.
• Conduct continuous professional development of the primary care nursing team.

Associated Assessment Criteria for Exit Level Outcomes 3.

• Assess, analyse, and interpret the community health status of individuals and families and communities of a rural and or urban community.
• Update the community profile of the catchment area annually to assess the needs of the community.
• Coordinate professional activities in the interprofessional team to identify and discuss the possible need for an extension of the current primary care facility.
• Participate in the entire process of planning, commissioning, and management of a primary care facility on all levels including all role-players.
• Explore dynamics that may impact the financial management in a primary care healthcare facility.

Associated Assessment Criteria for Exit Level Outcomes 4.

• Apply leadership and management skills in the management of the primary care nursing facility based on evidence from audits.
• Support learners in the primary care facility by carrying out practical patient care procedures.
• Conduct a needs analysis of the primary care nursing staff training needs.
• Develop a proposal to nursing management for training activities to be included in the annual institutional CPD plan for the primary care nursing facility.
• Interpret epidemiological data pertaining to child or adult primary health care and use data to plan a community awareness program and campaign.

Associated Assessment Criteria for Exit Level Outcomes 5.

• Explore how research is used as evidence guiding the practice of primary care nursing and communicate these findings to the interprofessional team.
• Record child health data according to guidelines to enhance the accuracy of morbidity and mortality data.
• Audit client records to evaluate standards of care in primary care nursing.
• Interpret qualitative and quantitative data related to primary care nursing and communicate these findings to the interprofessional team to improve the health of the primary care patient.
• Utilise communication and ethical reasoning skills to address ethical challenges associated with moral distress in the primary care facility.
• Apply results of systematic reviews to improve client experience and outcomes in primary care practice.

Associated Assessment Criteria for Exit Level Outcomes 6.

• Apply knowledge and prescribe essential, appropriate medication according to the patient's diagnosis in accordance with current policies on a national and provincial level at the primary care facility.
• Devise the patient caregiver with correct instruction and information when dispensing medicine to ensure compliance and commitment to the treatment regime.
• Cultivate the social and cultural determinants when prescribing treatment for a client in the primary care setting.
• Administer medicine in accordance with current procedural and regulatory measures in primary care.
• Evaluate the progress and treatment responses of prescribed medication in primary care.
• Apply pharmaceutical practices to ethical, legal, and therapeutic principles when prescribing and dispensing medicine at the primary care facility.
• Interpret client's clinical manifestations 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 or evidence in primary care nursing.
• Formulate comprehensive individual patient-centred and inter-professional treatment plans based on assessment findings in the primary care facility.
• Analyse effective communication during interaction with clients and demonstrate the ability to detect stressors within verbal and non-verbal communication of the clients in the primary care facility.
• Conduct a comprehensive assessment of a child for early identification of possible abnormalities, including history taking, physical examination, performing diagnostic procedures and interpreting findings in the primary care clinical practice.

Associated Assessment Criteria for Exit Level Outcomes 7.

• Promote community involvement through information sharing to promote positive health outcomes in primary care nursing.
• Assess and continuously monitor the patient outcomes, quality of patient care, patient safety, and satisfaction in primary care nursing.
• Formulate appropriate audit tools to identify actual and potential risks to patient safety and security at the primary care facility.
• Assess patient outcomes and quality of patient care. patient satisfaction and safety in the primary care facility.

Associated Assessment Criteria for Exit Level Outcomes 8.

• Design guidelines to ensure standards of care meet quality requirements in primary care nursing.
• Use statistical data to measure progress with quality assurance interventions of primary care nursing.
• Analyse data using epidemiological measuring principles to determine the impact of the burden of disease.
• Prescribe according to the medico-legal norms and guidelines to ensure standardized patient care in primary care nursing.
• Apply protocols for the technology management system to maintain cost and ensure effectiveness and effective service delivery through dispensing at the primary care facility.

Associated Assessment Criteria for Exit Level Outcomes 9.

• Advocate and portray the professional role in primary nursing patient care, communication with the community and lobbying for change.
• Advocate for a healthy environment for children based on evidence and available resources in the primary care setting.
• Evaluate participation in policy development, programme and project development and demonstrate advocacy for the clients, families, and communities within a primary care setting.
• Apply client advocacy principles to advocate for safe and quality care related to the treatment plan decided upon by involving the client in the primary care setting.
• Apply ethical decision-making and moral reasoning models in addressing ethical and human rights obligations in primary care nursing.
• Advocate for the inclusion of professional nurses from the primary care facility to serve on the planning committee/project team when planning a new facility.

Associated Assessment Criteria for Exit Level Outcomes 10.

• Assume responsibility for own professional development and those of the nursing team members assigned to you, to promote continuous professional development in primary care nursing to advance competencies and skills to improve nursing care standards.
• Justify the advantages and contributions of continuous professional development to primary care nursing practice.
• Promote and monitor CPD attendance for primary care nursing staff.
• Illustrate practical procedures for learners in the primary care facility.

Associated Assessment Criteria for Exit Level Outcomes 11.

• Utilise appropriate referral pathways to multi-sectorial and interprofessional team or community resources related to primary care nursing.
• Identify other health and associated problems of the client in the primary health care setting by engaging in interprofessional teamwork.
• Assess appropriate pre-referral emergency treatment to stabilise a patient before transferring to the next level of care (interprofessional team).
• Recognise possible obstacles that may influence effective interprofessional teamwork and team cohesion.

Associated Assessment Criteria for Exit Level Outcomes 12.

• Develop guidelines for dealing with disasters in the primary care practice area.
• Apply policies, guidelines, and strategies applicable to the national, provincial, and district levels of care to deliver quality primary care service.
• Compose a synopsis of the Health Care (HC) 2030 conceptual pillars of a person-centred primary care approach.
• Defend the extended meaning of primary care and the implementation thereof within the current South African health care system.
• Compare the key principles of primary care with the current national and provincial policies and guidelines.

INTEGRATED ASSESSMENT

Assessment consists of a continuous assessment system comprising formative and summative assessments.

Formative Assessment

Formative assessment tasks such as

• Quiz
• Draft of an essay or report
• Mock exam intended as a teaching and learning exercise or as preparation for a continuous summative assessment.

No marks, or a low mark for purposes of encouragement, are allocated to formative exercises.

Summative Assessment

Formative assessment consists of assessment tasks such as

• Assignments
• Case studies
• Tests
• OSCE
• Portfolios
• Workbooks

Learners' progress will be assessed at the end of a section of work rather than exclusively by final assessment at the end of the semester/year.

Assessments will be conducted in the subjects for both theory and clinical learning (WIL). In the subject templates the assessments are stipulated for both theory and clinical learning (WIL component) as well as the content that will be assessed.

The theory comprises 40% and Work Integrated Learning (WIL) comprises 60%. Learners must pass both the theory and WIL components to pass the subject.