Postgraduate Diploma in Primary Care Nursing

Purpose

The purpose of this qualification is to strengthen and deepen the learner's knowledge and expertise in Primary Care Nursing as a specialty. It will enable the Primary Care 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 Primary Care Specialist qualification will strengthen and deepen the knowledge and expertise in Primary Care nursing. The qualification will enable the Primary Care Nurse Specialist to engage in the respective specialist area of practice with in-depth knowledge, skills, attitudes, and values to enhance professional independence and optimum health outcomes.

In an often challenging and demanding Primary Care environment where people are cared for across life span often with numerous, multifarious and evolving health problems, it is imperative to ensure safe, independent, competent and effective practice within the ethical and legal parameters through training of the Primary Care Nurse Specialist with strong underpinning knowledge and capabilities to make sound decisions and prevent complications. The competencies acquired will entail screening, appropriate management, and prompt referral of health care consumers with specific and complex problems in primary care clinical settings.

The proposed curriculum is competency based with a robust component of work-integrated learning. Learners will be placed in a variety of clinical learning sites to facilitate integration of theory to practice and development of the expected competencies. Furthermore, the qualification utilizes learner centred approaches in teaching and learning thus providing the learner nurses with a variety of skills, knowledge and attitudes that will enhance the culture of lifelong learning and continuing professional development.

The qualification utilizes learner-centred approaches in teaching and learning, aimed at providing the 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 Primary Care Nursing qualification is aligned to the Higher Education Qualifications Sub-Framework, South African Nursing Council Post Graduate Diploma in Nursing Framework and competencies. This qualification will enable the Primary Care Nurse Specialists to function as leaders who are clinically focussed, service oriented, autonomous, innovative and able to render comprehensive Primary Care Nursing within the Legislative framework. The South African health care system has adopted a Primary Care approach which is nurse driven and requires a robust of Primary Care Nurse Specialists with in- depth knowledge, skills and attitudes to engage at the forefront. This Primary Care Nurse Specialist will be able to apply knowledge and expertise pertaining to theories, methodologies and techniques required to independently and competently function in a Primary Care setting. .

Furthermore, nursing has remained the backbone of the South African health system, whilst Primary Care Nursing remains the heartbeat of the South African health system. A Primary Care nurse specialist category was introduced to support the Primary Health Care system. The proposed National Health Insurance requires the Primary Care Nurse specialists who possess the skills to work independently to make sound decisions at any primary care setting. In the last five years, there were 229 Primary Care Nurse Specialists who were trained in the legacy qualifications in the institution, against 846 whose training was outsourced; therefore, there is a dire need for this cadre of nurse specialists.

Primary Care Nursing interventions across low and middle-income communities could save a million lives and increase average life expectancy by 3.7 years by 2030. Primary Care provides the 'programmatic engine' driven by Primary Health Care engineering to achieve Universal Health Care, health-related Sustainable Development Goals (SDGs), Norms and Standards, six health priorities, and health security. Evidence of the wide-ranging impact of investment in Primary Care continues to grow around the world, particularly in times of crisis such as the COVID-19 pandemic (WHO, 2021). In 2018, countries met to renew their commitment to primary care at Astana and to make a new declaration to strengthen Primary Care. Despite this global commitment to the principles and need for Primary Care, actual implementation has not lived up to expectations. African health systems remain under-resourced and hospital-centric, with Primary Care delivered by low-level and poorly trained nurses

The critical shortage of doctors requires strengthening of primary care specialist skills in reducing the burden of disease by scaling-up prevention, treatment, and care using 90-90-90 strategy for Human Deficiency Virus (HIV), Sexually Transmitted Infections (STIs) and Tuberculosis (TB), including Multi and Extreme Drug Resistant TB, injuries, communicable and non-communicable diseases to reduce the incidence, prevalence, and case fatality rates in South Africa. The health care issues in primary care settings solidify Primary Care Nursing as a critical complement to make health systems more resilient to situations of crisis. The Primary Care Nurse specialist would be more proactive in detecting early signs of epidemics and more prepared to act early in response to surges in demand for services.

The qualification will produce a nurse specialist who is competent to serve in a dynamic healthcare system, which requires healthcare professionals who can promote and provide excellence in care for people with kidney disease and their families through a comprehensive, multidisciplinary, evidence-based approach to Primary Care Nursing practice.

Recognition of Prior Learning (RPL)

There is no RPL for access to the Postgraduate Diploma in Primary Care Nursing. Applicants must meet the minimum entry requirements, which include a basic/ undergraduate nursing qualification and midwifery, as it forms the basis upon which to build a specialisation.

Entry Requirements

• 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.

Or

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

And

• Proof of current SANC registration as a Professional Nurse and Midwife for General Nurse with Midwifery.
• Registration with SANC as a Nurse and Midwife/General Nurse with Midwifery/Professional Nurse and Midwife.
• A minimum of two years' experience as a nurse (including community service experience).

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

• Advanced Foundations of Primary Care Nursing,16 Credits.
• Pharmacology in Primary Care Nursing, 24 Credits.
• Primary Care Nursing Adult, 24 Credits.
• Nursing Research, 16 Credits.
• Contemporary Issues in Primary Care Nursing,8 Credits.
• Clinical Nurse Specialist Practice,16 Credits.
• Primary Care Nursing Child, 24 Credits.

1. Practice and facilitate specialist primary care nursing within ethical-legal parameters of the profession.
2. Apply the knowledge of and facilitate evidence-based practice in the primary care specialist field to solve contextual problems and develop policies and guidelines.
3. Appraise and develop self, peers, and primary care 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 primary care unit, an educational entity, or a health service.
6. Engage in scholarly activities to inform evidence-based practice, education, and/or management.
7. Utilize, manage, and communicate data to support decision-making and research.
8. Render and coordinate health care consumer-centred specialist nursing practice within a continuum of care using the scientific approach, integrating biomedical and psychosocial sciences, including applied pharmacology in primary care.
9. Mobilize appropriate resources to implement standards of practice relevant to the primary care nursing specialty, 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 primary care specialty, utilizing the process of change management in the improvement of quality of care.

Associated Assessment Criteria for Exit Level Outcome 1

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

Associated Assessment Criteria for Exit Level Outcome 2

• Engage primary care nursing specialist practice, demonstrates understanding of the process of evidence-based practice
• Take application of evidence-based specialist practice into consideration, and the appropriate methodology of gathering evidence for practice.
• Use of evidence-based practice demonstrates knowledge of and critical analysis of the various levels of evidence.

Associated Assessment Criteria for Exit Level Outcome 3

• Demonstrate leadership skills through application of appropriate leadership styles, principles and theories of Primary Care nursing.
• Facilitate Continuous Professional Development (CPD) for self and others is effective 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 demonstrates 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.
• Demonstrate understanding of the 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

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

Associated Assessment Criteria for Exit Level Outcome 5

• Demonstrate understanding of levels and or classification of the respective primary care units.
• Determine commissioning task takes into consideration the burden of diseases and priority services as current events.
• Participate in the evaluation of the existing primary care settings, and demonstrate knowledge of guidelines for provisioning a primary care unit.
• Engage in planning and commissioning, demonstrating understanding of the role and responsibilities in this task within the inter- and intra-professional team.

Associated Assessment Criteria for Exit Level Outcome 6

• Practice in the respective specialisation demonstrates knowledge of appropriate search engines and databases for review of literature to inform evidence-based practice.
• Use appropriate methods to generate evidence for utilization in primary care nursing practice (e.g., research, systematic reviews, etc.)
• Demonstrate awareness of the peer-reviewed journals and use for sharing of evidence.
• Base activities in the specialist practice 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

• Gather all documents, data/information in the context of the specialist practice for utilization and storage in accordance with the set standards.
• Utilize comprehensive data, information, and emerging evidence pertinent to the respective specialist practice.
• Gather and critically analyse problem identification, diagnoses, and opportunities for improvement that are based on assessment data from the patients/clients, families, communities, including current scientific evidence.
• Demonstrate documentation respect for intellectual property, and is without plagiarism

Associated Assessment Criteria for Exit Level Outcome 8

• Demonstrate understanding of the position primary care nursing specialist service within the health care system.
• Be conversant with the full range of services within the specialist area of practice.
• Render integrated promotive, preventive, curative, rehabilitative, and palliative care in a healthcare continuum.
• Render primary care nursing specialist care in accordance with national and international standards and protocols of the primary care nursing specialist field.
• Base Congruent formulated diagnoses with the health care consumers' clinical manifestations/data on accurate analysis and interpretation of data obtained from scientific, laboratory, diagnostic, technological, and psycho-sociocultural assessment, including consultation of relevant/current literature/evidence.
• Individualise planned nursing interventions considering health care consumers' needs, values, beliefs, preferences, culture, and contextual variables, for example, disease burden, health risks, national priorities, etc.
• Plan nursing interventions based on formulated diagnoses, and application of primary care nursing specialized knowledge and skills (competencies), including applied pharmacology in collaboration with the inter- and intra-professional team.
• Plan nursing interventions are implemented timeously, accurately, safely, and effectively in accordance with set evidence-based standards, guidelines, protocols, algorithms, etc., specific to the specialist field.
• Plan health care interventions in collaboration with the health care consumer, family, and relevant members of the health care team.
• Document and revise timeously nursing and critical analysis effectively based on the monitoring and evaluation data and reach a sound clinical judgement.

Associated Assessment Criteria for Exit Level Outcome 9

• Demonstrate understanding of the infrastructure and equipment needed in the primary care nursing practice area of specialisation.
• Employ sound asset management principles to ensure appropriate, adequate, well-maintained, and up-to-date equipment.
• Take into consideration the assignment of staff to nursing care, the primary care nursing specialist qualification and its competencies, experience, standard health care consumer for the area of specialisation, job description, and skill mix.

Associated Assessment Criteria for Exit Level Outcome 10

• Collaborate within the inter- and intra-professional team by engaging in health dialogue, shared leadership, decision making, and sound clinical judgement.
• Identify, share, and collaboratively solve practice problems in the primary care nursing specialist area by informed decisions and sound clinical judgement.
• Consultation is sought and provided appropriately and timeously in the provision of holistic care in a healthcare continuum through awareness of one's competence.
• Carry out patient referral appropriately and timeously as dictated by the patient's condition and in accordance with the referral guidelines.
• Promote participation in the inter- and intra-professional team, visible and recognized by the members of the team

Associated Assessment Criteria for Exit Level Outcome 11

• Demonstrate participation in the development of policies, programmes, and projects, understanding of the steps in and or levels of the development of policies, programmes, and projects.
• Demonstrate participation in project and policy development, knowledge of own role and responsibilities within the inter- and intra-professional policy/project team.
• Participate in policy development, programme and project development, demonstrates advocacy for the nursing profession and patients/clients, families and communities in the specialist area.
• Participate in project development includes appropriate communication (negotiation, bargaining, assertiveness, persuasion, etc.).
• Provide timely and adequate feedback to relevant stakeholders as necessary.

Associated Assessment Criteria for Exit Level Outcome 12

• Demonstrate knowledge of the process and or steps of development of policies, standards, guidelines and protocols.
• Pre-determine the process of development of policies, standards, protocols, and guidelines that involve the relevant stakeholders.
• Use the process of development and evaluation or testing of guidelines and protocols to the appropriate methods.
• Implement the new policies, protocols, and guidelines in the specialist area to demonstrate understanding and application of the change process.
• Collaboratively revise developed policies, protocols, and guidelines at appropriate intervals and approve as per the institutional policy for the specialist area.

Integrated Assessment

The assessment strategy for the Postgraduate Diploma in Primary Care Nursing comprises formal and informal assessments.

Formal Assessments

The formal assessments will be in the form of Formative and Summative Assessments.

Formal assessments will determine learners' progression between semesters and completion of training at the end of the programme.

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, i.e., written tests, assignments, case studies, project (quality improvement project, community intervention and assessment project), and clinical assessments in real-life settings.

Integration of theory and work-integrated learning (WIL) will be assessed separately, and marks obtained by the learners will be published separately (theory mark and practical mark).

The formative clinical assessments are conducted in the clinical areas, and their average percentage contributes 30% towards the final clinical result.

Summative assessments are conducted at the end of each semester. Summative assessments contribute 70% towards the final examination result. Theory examination papers will be set for each module. WIL is assessed in the form of a comprehensive clinical examination in each semester. This comprehensive examination will embrace all the modules that have a clinical component in a semester.

WIL is assessed separately and must be passed for the learner to complete training.

Informal Assessments

Informal Assessments are used during facilitation and as part of the consolidation of what learners may have learnt on their own. They provide an opportunity for the Facilitator to establish the learner's 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 to reflect on what they have learnt. Questions on the application of theory will be asked by the Facilitator to determine the learner's level of understanding and comprehension.
• Group discussions: Small group discussions will provide an opportunity for the Facilitator to observe a few learner's discussions on a specific assigned topic in a limited period, thus determining the depth of their understanding and comprehension of the subject matter.
• Presentations: Learners are asked to do presentations in class on selected topics. These topics may be done in summary form. The Facilitator will be able to gauge the learner's level of understanding, application and comprehension of the subject matter.
• Jigsaw: Learners are divided into groups to discuss to learn about a topic in class. The individual learner will be assigned specific focal areas of content in each group. Each learner will have an opportunity to present to their group, then consolidation in each group is done before further presentations to the whole class are made. This will provide an opportunity for the Facilitator to determine the learner's ability to participate in a group, teamwork, and every learner's appreciation of collaboration and cooperation.
• Simulation: It provides an opportunity for learners to see the relevance of their learning in the practice environment, while it provides the Facilitator to observe learner performance in a controlled and safe environment. This is more relevant in Primary Care nursing as technical processes will have to be practised before exposing learners to real-life situations.
• Demonstration: Learners demonstrate specific skills in both simulated and real-life situations during supervision. the Facilitator will have the opportunity to observe learners' performance as an individual or in a group.
• Role Play: This assessment approach in Primary Care nursing provides an opportunity for learners to practice skills such as physical assessment. the Facilitator observes learners' level of clinical competence and provides feedback for improvement where necessary.
• Debate: The debate will be applicable where learners are assigned topics to debate about, especially topics on interesting topics and dilemmas in nursing practice, such as legal prescripts and restrictions in practice. The Facilitator can act as a Moderator whilst observing the level of understanding, depth of debates, and comprehension of the content by learners.