South African Nursing Council (Under the provisions of the Nursing Act, 2005)

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1 South African Nursing Council (Under the provisions of the Nursing Act, 2005) web: P O Box 1123, Pretoria, 0001 Republic of South Africa Tel: Fax: Pretorius Street, Arcadia, Pretoria, 0083 NURSING EDUCATION AND TRAINING STANDARDS INTRODUCTION The SANC shall, by administrative rules and regulation, set standards for the establishment and outcomes of nursing education and training programmes, including clinical learning programmes and approve such programmes that meet the requirements of the Nursing Act (No. 33 of 2005). As the regulator of nurses and midwives in South Africa, the mission of the SANC is to: Safeguard the health and wellbeing of the public, Maintain a register of nurses and midwives: Set and maintain standards of education, training and practice Ensure that nurses and midwives keep their skills and knowledge up to date, and uphold the standards of their professional code Ensure that nurse and midwives are safe to practice by setting legal ethical framework for their practice. Provide mandatory guidance and additional advice to people designing and developing education programmes

2 BACKGROUND INFORMATION AND CONTEXT In 2001 the World Health Assembly (WHA) supported the call to strengthen the nursing and midwifery professions by passing a resolution WHA54.12, validating WHO s commitment to the scaling up of the health professions. The need for global standards has arisen for several reasons: the increasing complexities in health care provision, the increasing number of health professionals at different levels and the need to assure more equitable access to health care. The global standards for the initial education of professional nurses and midwives are intended to serve as a benchmark for moving education and learning systems forward to produce a common competency based outcome in an age of increasing globalization. Nursing education and training across South Africa is responding to changing needs, developments, priorities and expectations in health and healthcare. Nurses who acquire the knowledge, skills and behaviors that meet our standards will be equipped to meet these present and future challenges, improve health and wellbeing and drive up standards and quality, working in a range of roles including practitioner, educator, leader and researcher. As autonomous practitioners, nurses will provide essential care of a very high standard and provide complex care using the best available evidence and technology where appropriate. Our standards aim to enable nurses to give and support high quality care in rapidly changing environment. The standards reflect how future services are likely to be delivered, acknowledge National Health Priorities, Re-engineering Primary Health Care and National Health Insurance. Nurses and midwives must be able to develop practice, and promote and sustain change. 2

3 GLOSSARY: Accreditation : A process of review and approval by which an institution, programme or specific service is granted a time-limited recognition of having met certain established standards. Assessment : A systematic process for collecting qualitative and quantitative data to measure, evaluate or appraise performance against specified outcomes or competencies. Clinical learning: Part of the educational process that takes place in any practice setting in hospital or community Code of ethics: The rules or standards governing the conduct of a person or the conduct of the members of a profession. Competence : The combination of knowledge, psychomotor, communication and decision-making skills that enable an individual to perform a specific task to a defined level of proficiency. Competency based education: Teaching, learning and assessment activities that are sufficient to enable students to acquire and demonstrate a predetermined set of competencies as the outcome of learning. Curriculum : A systematic process that defines the theoretical and practical content of an education programme and its teaching and evaluation methods. Determinants of health: The range of personal social economic and environmental factors which determine the health status of individuals, groups and population. Domain: Is a sphere or field of activity concern or function. 3

4 Graduate: One who has received an academic and professional qualification in an institution higher of learning Practical experience: Student time in nursing and midwifery practice settings for acquiring and applying knowledge, skills and behaviours and demonstrating competency in the practice of nursing and midwifery. Protection of the public: To ensure the safety of the public through its regulatory mechanisms. Quality improvement: An ongoing process for determining the effectiveness of actions and making needed improvements. Recognition of prior learning: Procedures or processes whereby students are assessed and may be given recognition for knowledge and skill acquired through past learning and experience relevant to current programme of learning Standard: Statement of a defined level of quality that articulates the expectation of initial nursing and midwifery programme. Work integrated learning: A component of a learning programme that focuses on the application of theory in an authentic, work-based context. It addresses specific competences identified for the acquisition of a qualification. The summary below highlights the structure and format of the nursing education and training standards developed: 4

5 1. PROGRAMME GRADUATES 1.1. OUTCOMES Graduates adhere to Duration & structure of course Course book with professional values, norms facilitates achievement of details of course and standards competencies Copy of full course Graduates reflect Total clinical practice hours are outline established competencies adequate for graduates to achieve in nursing and midwifery competency Curriculum map/ grid practice Description of clinical Clinical practice learning experience commences from the first year of training Outline of the total clinical experience Theory precedes practica Duration and location Practica hours are not less than of placements 60% of the total duration of course Minimum of 8 weeks uninterrupted practica at end of course to allow for transition into workplace. 5

6 Midwifery component must allow for continuity of care and facilitate acquisition of midwifery competencies 6

7 Midwifery component allows for integration of theory and practice with a minimum of 50% theory and 50% practica Structure of course facilitates extended period of placement in the clinical area toward the end the component to allow for consolidation of competencies 7

8 Graduates show sound Curriculum is mapped against SANC Table of competencies understanding of the competency framework matched against determinants of health Programme outline clearly sets out curriculum content. plan for opportunities for the Course content with graduate is to obtain competence the rationale Selection organization and sequencing of curriculum allows graduate to attain competencies Organization of the learning programme focuses on nursing and current nursing issues with focus on health promotion, disease prevention and care of individuals, families and groups across the life span Description of the content indicating reference to relevant current reports. Include legal and professional reports Focus on evidence based content Benchmark against 8

9 Nursing practice is inclusive of national and promotion and maintenance of international best health and prevention of illness practices Learning opportunities must allow graduate to assess, plan, implement and evaluate care according to clients needs Learning records provide evidence of learning taking place within the multidisciplinary team with opportunities for delegation, supervision, leadership and coordination of care in various health contexts Curriculum addresses competencies related to professional values, legal & ethical issues and policy Description and examples of a range of learning experiences across the course Lesson plans indicating a range of learning experiences Identification of content focused on research throughout course Teaching and learning content focused on 9

10 development. health informatics Curriculum is responsive to health care issues, national and international and includes health care priorities, chronic disease management, mental health and primary health care Curriculum is responsive to regional issues where applicable The focus of the midwifery component is women centred and primary health care Content shows focus on pharmacology and therapeutic medication management across the course List and description of electives and relevance to nursing Evidence based approaches is applied to theory and practice. Clinical learning experiences provide evidence of promotion of 10

11 midwifery models of care in the hospital and in the community Information technology and information management that support health care are integrated in the curriculum Graduates of an initial programme in nursing and midwifery meet regulatory body standards (requirements) leading to professional licensure / registration as a nurse and a midwife The total length and structure of the course allows the graduate to attain competence The total length of clinical experience allows the graduate to meet competence outcomes The academic content prepares the graduate for the timing and length of the clinical placements Course handbook with details of course length and structure Copy of course outline Map / grid of clinical learning experiences related to competencies. Statement of total 11

12 The total clinical learning professional experience hours is not less than 2800hours experience across the course The extended period of placement of the graduate toward the end of training allows the graduate to consolidate competencies and facilitates transition into the work place. Description of the length and timing of the last clinical learning experience in the course. The course outline that specifies continuity of midwifery training and achievement of midwifery competencies Theory and practice is integrated across the midwifery course and 12

13 50% ratio of theory to practice Graduates are awarded a professional qualification Graduates are eligible for entry into advanced nursing and midwifery programmes Completion of training records Assessment policies indicating moderation processes Quality management system Conferment of certificate, diploma and/degree Course must clearly indicate minimum credits at an NQF Level higher than that of the qualification Evidence of students experience against expectations of course Record of assessments and finalization of outcomes Curriculum outline with clear lines of articulation Articulation options must be mapped out 13

14 NEI s employ methods to track professional success Alumni Research studies on efficiency of Evidence of research findings and progression of community service professionals Minutes of education of each graduate Collaborative meetings with collaborative meetings services where community service professionals are place Graduates are Clinical learning experience Curriculum Map PROGRAMME knowledgeable practitioners who supports learning activities and indicating congruence GRADUATE adhere to the code of ethics and provides opportunities to attain between ATTRIBUTES standards of the profession learning outcomes. competencies and Processes/ protocols demonstrating learning experience. promotion and adherence to a List of health service professional code of conduct. providers Clinical learning experience Signed formal programmes provides for learning agreements between of curriculum content. NEIs and service 14

15 Memorandum of understanding between NEIs and Services where students are placed for experience. Risk assessment and risk mitigation plans in place in areas where students are placed. Collaborative approach to evaluation of students professional experience placement Supervision models for clinical experience placement and relationship to achievement of learning outcomes. Academic staff involved in supporting and assessing students are experienced and adequately prepared for their role providers Guidelines for student activities on clinical taking into consideration risks Post placement evaluation of students experience. Description and rationale for how students are supervised Outline of preparation programmes and resources for staff. Policies on minimum 15

16 qualification and experience NEI s prepare graduates who demonstrate: Sound scientific knowledge Clinical competence and can make sound scientific clinical judgments Use of evidence in practice Cultural competence The ability to practice in the health-care system to meet population needs Critical, analytical and reflective Research and use of evidence based practice (EBP) Curriculum content and clinical experience promotes and supports nursing practice support for social inclusion, respect for individual choice and acknowledgement of diversity. Evidence of NEI working in partnership with clients, families, Preparation and development of models and resources for assessment. Length and structure of course allows for attainment of competency. Clinical experience and hours of practice allow for graduate to attain competence. Course handbook Copy of course outline. 16

17 thinking The ability to be effective patient advocates and professional partners with other disciplines in health-care delivery Community service delivery and demonstrate social responsibility Effective leadership ability and continual professional development Fiscal responsible practice Accountability Independent practitioners e.g. independent decision makers The art of nursing e.g. caring Balanced approach to work and social life Ethical conduct communities Learning programmes promotes health and well-being and empowers students to make choices to promote care and safety Role of nurse clearly identified and understood Graduates: Keep updated Practices independently Value evidence, understand and support research. Demonstrate communication skills and interpersonal relationships - for 17

18 safe and effective practice. Listen with empathy and respond warmly and positively to people. Use a range of skills and technology Pursue accurate assessment, appropriate diagnosis and decision making Work toward understanding of the level of competency expected NEI s define and make public The mission and vision of the NEI is Vision of the NEI PROGRAMME GOVERNANC their vision, mission,, values and displayed within the NEI and on the Mission statement DEVELOPMEN E objectives NEI s website. Strategic plan T AND There is a strategic plan for the NEI Website of the NEI REVISION which indicates how objectives are to be met 18

19 NEI s educate their students through the programme to meet the health-care needs of their societies A situational analysis has been done within the last 5 years to review the health care needs of the local community. The course content of the curricula reflects evidence that the local health care needs were considered. The examination papers are pertinent to the local health needs of the community. Situational analysis Curriculum for all programmes. Examination papers and marking guides NEI s clearly define the educational and clinical outcomes of the programme The curricula reflect the educational outcomes for each programme offered at the NEI. The curricula reflect the clinical outcomes for each programme with a clinical component at the NEI. Curriculum for each programme 19

20 NEI s employ nursing or midwifery lecturers with relevant expertise in the subject matter and the ability to develop and revise their programmes Lecturers are registered nurses and midwives with an additional qualification in nursing education Lecturers have at least a Bachelor s degree and an academic qualification at least one level higher than the level of the programme they are teaching. Lecturers have at least 5 years clinical experience in the speciality area in which they teach. The curricula have been systematically reviewed within the last 5 years and the results used to revise the educational programme. Staff establishment Staff allocation lists Evidence of qualifications of all academic staff members. Curriculum for each programme Curriculum review guidelines. Minutes / reports of curriculum review committee 20

21 NEI s have in place and use a system of formative and summative assessment of the programme s educational and clinical objectives and outcomes A policy makes provision for the confidential, effective management of tests and examinations during the development, processing and writing phases. A written plan for the systematic, reliable and valid evaluation of all components of the programme, based on the outcomes for each programme, and including a range of assessment methods, is implemented. A policy exists for the processing, review and publishing of examination results as well as an appeals procedure Examination policies and procedures Signed code of conduct by examiners and invigilators Examiners reports Letters of appointment of external examiners Samples of tests and examinations Agreements with external moderators Written appeals procedure Samples of published examination results 21

22 Job analysis document Job descriptions for all academic staff members NEI s define role descriptions for theoretical and clinical educators including, but not limited to, clinical lecturers, mentors, and preceptors. Formal institutional human resource policy in place in the NEI. The staff establishment size and composition is sufficient to provide teaching and guidance to ensure student progress and practice readiness Quality control programme is An accurate job analysis is carried out prior to recruitment of new staff members Job descriptions for each category of staff indicate knowledge, skills and qualities required for the job. The job description for each academic staff members states the amount of time to be spent in theoretical and clinical supervision 22

23 operational which will include personal performance appraisal, assessment of the quality of education given, moderation of assessment NEI s have a system in place to ensure accountability of staff Sound induction programme in place NEI s are an integral part of a The nursing education institution is Certificate from the ACCREDITATI higher education institution that accredited with the HEQC. HEQC. ON meets internal standards, recognized accreditation and/or governing body requirements The nursing education institution functions within an agency agreement with an accredited HEI. Memorandum of agreement with an HEI Reports of internal audit committee 23

24 NEI s have criteria in place that meet accreditation standards for clinical practice components of The nursing education institution has a system in place for internal audit of the structure, processes Results of the internal audit their programmes, academic and outcomes of the NEI content and the demonstration of professional outcomes There is evidence that an internal audit has been carried out within the last 2 years and the NEI was found to be compliant with the criteria in the audit tool NEI s and their programmes are recognized or accredited by The NEI is accredited by the SANC. Accreditation reports credible, relevant professional and academic bodies and re-accredited The NEI is accredited by the HEQC as required NEI s have accessible, The facilities promote quality Site inspection reports INFRASTRUCT current and relevant physical learning, education and comfort of Inventories URE facilities including, but not limited the staff and students Inter-institutional 24

25 to, classrooms, clinical practice The equipment and other resources agreements sites, information and are sufficient, appropriate, well Staff and students communication technology, clinical maintained and accessible to staff satisfaction survey simulation laboratories and and students results libraries. The resource centre is accessible to students and staff The resources are appropriate and continually updated according to Equipment maintenance contract, service records Records of utilization the needs of students and staff of equipment and The skills laboratory / simulation simulation area area facilitates adequate Staffing policy for preparation of students for clinical placements resource centre and simulation areas. Policy on control of resources Occupational health and safety plans and 25

26 NEI s have a system and policy in place that ensures the safety and welfare of students and lecturers NEI s have a system in place for student support services. The facilities promote safety of the staff and students The NEI has a formal agreement which include a description of the nature of the agreement and the roles and responsibilities of both reports Disaster plan. Site inspection reports parties with the following organizations: The hospital where students are allocated The Community services where students gain experience Other national and /or internationally based NEI s The academic staff of the NEI are 26

27 members of a professional organization The staff of the NEI meet regularly with the staff members of the facilitated institutions and engage in mutually beneficial projects NEI s have professional support personnel and human resources to meet programme and student demand Students and staff have access to a counselling and/or and academic support service. There are sufficient academic, support and management staff to support the activities of the NEI Staff establishment / agreement with a counselling service. Staff establishment NEI s have a budget allocation and budget control that meets programme, lecturer and Provision is made for revenue generation and collection and management of student fees and Financial policies and procedures Financial statements 27

28 student needs. debt. The annual budget and financial resources reflect the strategic goals and activities of the NEI and allow for escalating costs and growth of the NEI Budget Audited statements. Minutes of the finance committee NEI s reflect successful Inclusive of global competencies Agreements with PARTNERSHIPS partnerships with the academic institution where their programmes are located, with other disciplines, with clinical sites, with clinical and professional Addresses national and regional health needs and priorities Meets institutional and community expectations affiliated organizations Minutes of meetings / reports of mutual activities. organizations and with international partners. An evidence based programme based on analysis of disease profiles, health workforce needs and service delivery gaps Membership cards / documents of professional organization 28

29 ICN framework of competencies National DOH nursing strategies WHO millennium development goals Institutional policies National Human Resources Plan for Healthcare Community Needs Assessment Health Strategy of SA 29

30 3.PROGRAM CURRICULUM 3.1. CURRICULUM DESIGN NEIs design curricula and NEI s deliver programmes that take into account workforce planning flows and national and international health-care policies Inclusive of global competencies Addresses national and regional health needs and priorities Meets institutional and community expectations An evidence based programme based on analysis of disease profiles, health workforce needs and service delivery gaps ICN framework of competencies National DOH nursing strategies WHO millennium development goals Institutional policies National Human Resources Plan for Healthcare Community Needs Assessment Health Strategy of SA NEI s plan and design curricula to meet national and international education criteria, and professional and regulatory requirements for practice Meets HEQF requirements Meets CHE (HEQC) requirements Meets the SANC requirements for registration of professional qualifications Qualification registered on NQF Certificate of accreditation by CHE (DHET) 30

31 Programme designed to meet the Letter of approval scope of practice of relevant from the SANC categories of nurses Senate & Council Offer programme that is nationally minutes and internationally aligned to SANC Regulations for regulatory framework requirements nursing education and scope of practice Curriculum designed includes current evidence based practice in nursing education NEI s provide classroom and clinical learning that delivers the knowledge and skills required to Clearly defined competency levels and standards for each qualification type SANC Regulations for nursing education and 31

32 meet the needs of their respective populations. Clinical mentoring by competent adequately skilled practitioners scope of practice: HEQF requirements Learners have adequate exposure Assessment policy and practice to various appropriate clinical experiences ( real world ) Reports of accredited clinical facilities that Prepares learners to transition into meet varied health a variety of practice areas needs Develop and promote culturally Curriculum supported sensitive practice by evidence based research and practice Learner employment statistics NEI s establish and demonstrate balance between Use of curriculum development approach that integrates conceptual Curriculum framework - ratio between theory 32

33 theory and practice components of and contextual knowledge and practice the curriculum Distribution of hours between SANC Regulations theory and practice allocated as per Clinical hours the credit allocation. Simulation hours Clinical learning Theoretical components supported experiences by appropriate and adequate practice allocation and Clinical education accompaniment to develop model feedback competent practitioner reports Knowledge, skill and attitude Integration of theory practice model integration clearly mapped in feedback reports curriculum NEI s use recognized approaches to teaching and learning in their programmes, Teaching methodology to enable learner development Lecturers have adequate and Micro curriculum map Learning experiences 33

34 including, but not limited to, adult update skills to facilitate as listed education, self-directed learning, e-learning and clinical simulations. Facilities adequate and and resources appropriate are for Learning Resources and facilities available delivery of programmes asset register NEI s provide classroom and clinical learning based on established competencies and grounded in the most current, reliable evidence. Evidence based research used in determining the required competencies, competency level and context/s Facilitators of programmes have adequate skill and expertise Use of field experts in cooperated into programmes A continued development programme in place for lecturers Qualifications of Nurse Educators Register of visiting lecturers, field experts Evidence based practice models 34

35 Learning content NEI s enable the development of clinical reasoning, problem solving critical and reflective thinking in their programmes. Multiple contexts and global issues are incorporated in both theoretical and clinical components Facilitation of programmes promotes learner centred approach Teaching methodology Micro curriculum Assessment system Assessment reports Micro curriculum includes teaching and learning approaches that promote critical thinking and problem solving e.g. problem based learning, role playing, case presentations, reflective learning Programme evaluation structure in place for learners and internal 35

36 stakeholders Appropriate tools and action plans NEI s conduct regular evaluations of curricula and clinical learning, and include student, client, and stake-holder and partner feedback. A quality management system in place Meets the SANC and CHE audit requirements Internal and external moderation of programmes Formal self assessment of quality of programmes completed annually Annual review reports Quality Management system audit reports Programmes are aligned to NQF and SANC regulations allowing learner to progress as a practitioner further studies and occupational Trends from stakeholder feedback Class timetables indicate visiting lecturers 36

37 3.2. CORE CURRICULUM succession Programme indicates multidisciplinary facilitation planned Nursing or midwifery Interdisciplinary facilitation and Database of experts in programmes offer opportunities mentoring the field of study for multi-disciplinary content and learning experiences. included in the faculty/department/n EI Nursing and midwifery Curriculum committee is Minutes of curriculum curricula provide core content that established to ensure core content committee. will enable their graduates to meet is included. Annual review the established competencies Core content is flexible and reflects current community, healthcare documents. trends and issues, research findings Curriculum map. and innovative practices. Curriculum Committee Core content identifies with minutes reflect input national and international trends. from NEI s. 37

38 Nursing programmes provide core content in nursing theory, practice, interventions and scope of practice Appropriate course sequencing is in place. There is congruence between theory and practice. Meaningful input from Nurse Educators into content and teaching/learning approaches Millennium Development Goals are included in the content. Curriculum and learner records Midwifery programmes provide core content in midwifery theory, practice, interventions and scope of practice for strengthening health systems through the primary health care approach Nursing and midwifery programmes provide supervised Content identifies national and international targets for speciality. Content emphasises a primary health care approach Students are placed in an appropriate variety of clinical Tracking and monitoring of clinical hours. Adequate preceptor: student ratio. Documentation verifies student learning experiences. 38

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