TANZANIA NURSING AND MIDWIFERY COUNCIL STANDARDS OF PROFICIENCY FOR NURSING AND MIDWIFERY EDUCATION AND PRACTICE IN TANZANIA Revised, 2014 Tanzania Nursing and Midwifery Council P.O.Box 6632 Dar es Salaam Tanzania 1
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TABLE OF CONTENTS CONTENT PAGE FOREWORD 4 PREFACE 5 ABBREVIATIONS/ACRONYMS 6 INTRODUCTION 7 SECTION ONE: Standards of professional performance pertaining to nursing practice 11 SECTION TWO: Standards of professional performance pertaining to nursing education 24 SECTION THREE: standards of professional performance pertaining to nursing research 41 SECTION FOUR: standards of professional performance pertaining to nursing management 43 REFERENCES 46 REPAGING IN THE TABLE OF CONTENTS DURING TYPE SETTING 3
FOREWORD These standards of proficiency for midwifery practice in Tanzania were developed by working group assembled by the Tanzania Nursing and Midwifery Council constituted by Midwives from education and practice settings. With mandate from the Nursing and Midwifery Act, 2010, the Council realized a need to review the existing standards in order to accommodate new trends and support the initiative to ensure Tanzanians are receiving quality and safe services. The elements in the standard proficiency indicate the acceptable parameters for professional practice, areas of competencies, core competences and standards for nursing and midwifery education and practice. They have been developed to be in line with the scope of practice of nursing and midwives in Tanzanian context. In addition, these standards will help educators when they prepare their curriculum, as they prescribe expected competencies and proficiency of the nursing and midwives in Tanzania. Ultimately, they will also assist in monitoring and evaluating the quality of nursing and midwifery care. It is the TNMC hope that these standards of proficiency for education and practice will be used in nursing and midwifery education and practice in order to improve the quality of care provided to individuals, families and communities in Tanzania. Dr. Khadija Innocensia Malima TNMC - Chairperson 4
PREFACE Midwifery services are undergoing many changes in order to cope with political, social, technical scientific and pathological transformation, changes. In addition, reviewed priorities guided by national and international decisions such as the Millennium Development Goals, Task Shifting, MAM and the vision 2025 have necessitated TNMC to think of a need to review standards of proficiency for education and practice in Tanzania. This document consists of the following: - The scope of Midwifery practice - The rationale - The standards - Areas of competences - Core competences TNMC hopes that this document will provide necessary guidance to nursing and midwifery trainer who will subsequently be able to prepare midwives capable of functioning competently. Lena Mfalila Registrar 5
Abbreviations/Acronyms CFP - Common Foundation Programme TNMC - Tanzania Nursing and Midwifery Council ICN - International Council of Nurses 6
INTRODUCTION Background For over half a century, the Tanzania Nursing and Midwifery Council - (TNMC) has acted as an authority responsible for improving nursing service and education in the country. Today as the nurses shortage intensifies against a background of growing changing health needs, health service reforms and expansion, Millennium Development Goals, Vision 2025, advances in scientific knowledge and technology make new avenues for professional nurses to meet required standards of competence. TNMC believes that it is timely, to take immediate steps of defining the range and the scope of knowledge, skills and competences expected of a nurse in the country. In undertaking this activity a number of professional bodies from different countries and the International Council of Nurses (ICN) framework of competencies for the registered nurse were consulted as the initial benchmarking against which all other competencies in the continuum have been set. Assumptions 1. Registered nurse s role is pivotal in the continuum of the delivery of nursing care 2. Competences can be shared across two or more levels of the continuum but in general are progressive in terms of complexity from support workers to advanced practice registered nurses 3. The competences are focused and described in terms of practice rather than stating academic levels 4. There is in place a coherent competence based career framework that encourages progression through lifelong learning, branching, and recognition of existing competences. The meaning of standards of proficiency In this context the standards of proficiency is defined as the necessary skills and learning possessed by nurses. They are legal guidelines for practice of nurses and midwives in Tanzania. The standards of proficiency in Tanzania cover aspects of nursing care, nursing education, nursing research, and nursing management whose activities are carried out in health care and educational institutions. However, often times such activities are also carried out in clinics, homes, gatherings and any relevant setting The purpose of setting standards of proficiency The purposes of setting standards of proficiency for nurses and midwives are (i) to describe the responsibilities for nurses and midwives. (ii) to protect the consumer of nursing and midwifery services in the country, and (iii) to establish means for evaluating the care nurses and midwives provide. 7
Principles guiding standards of proficiency The standards are underpinned by guiding principles that establish the philosophy and values of the TNMC s requirements for programmes leading to entry to the roll or register. These principles provide the foundation for the outcomes/standards of proficiency for entry to the specialized nursing education programmes and to the register. As practice takes place in the real world of health care delivery it is inextricably linked to other aspects of fitness, that is fitness for purpose, professional academic awards and professional standing. Preparation: Fitness for practice The primacy of practice underpins the requirements for standards of proficiency and must be reflected in all programmes of preparation for entry to the register. Practice-centered learning The primary aim in nursing education programmes is to ensure that students are prepared to practice safely and effectively to protect the public. Theory and practice integration Safe and effective practice requires integration of theoretical knowledge, which in turn informs practice. Evidence-based practice and learning It is essential to utilize the best available evidence to inform practice. This includes searching for the evidence, analyzing, critiquing and using finding to improve practice. Service: Fitness for purpose Nursing must relate to the changing needs of the health services and the communities that they serve, responding to current and future needs. Provision of care The provision of nursing care requires the capacity to assess needs of various clients/groups, diagnose, plan, implement and evaluate care in different settings. Care practice must not only reflect collaborative working with health care team but also involve patients and clients, and their careers in the planning, delivery and evaluation of care. Management of care The nursing role involves taking and accepting leadership roles, which includes responsibility, accountability, delegation, and supervision. A health for all orientation The holistic care perspective extends beyond a disease orientation to include health promotion and education for all irrespective of class, creed, age, gender, sexual orientation, culture or ethnic background. Principles of equity and fairness are fundamental professional values. 8
Lifelong learning Lifelong learning requires continuing professional development to adapt and initiate change. Quality and excellence One of the fundamental underpinnings of clinical governance is quality of nursing care. It is therefore necessary that nursing standards of proficiency encompass the capacity to contribute to this wider health care agenda and quality must be addressed within all programmes of preparation. Recognition: Fitness for award Education for practice must be established at the level and pace of learning commensurate with the demands of complex and professional practice. Education for practice must be designed to meet the needs of the health services and communities and be structured to meet the specific needs of the profession. Level of learning The level of learning must be such as to facilitate the achievement of knowledge, understanding and skill acquisition, and the development of critical thinking, problemsolving and reflective capacities essential to complex professional practice. Nature of learning Nursing education programme must reflect the integration of relevant and sound theoretical knowledge with experiential learning derived from practice (practice-centered education). Access and credit Nursing education programme should value prior learning, which provide a wide access to programmes and advanced standing through appropriate accreditation. Flexibility, integrity and progression Flexibility on modular design and structuring of the programme into a common foundation and branch element should not compromise overall integrity and progression. Educational quality Programmes must be established upon sound academic and professional quality assurance processes that address professional learning and, in particular, the standard of proficiency to be achieved. Responsibility: Fitness for professional standing The social contract between the profession and society include not only the responsibility to provide competent, safe and effective care but, also to maintain the highest standards of professional conduct and ethical practice. Adherence to the TNMC Code of professional conduct: An essential condition of entry to the profession is the acceptance and internalization of 9
the Code of professional conduct. This code provides the foundation for the standards of proficiency and must be reflected at all stages of programmes of preparation. Responsibility and accountability Professional nurses must take personal responsibility for their actions and omissions, and fully recognize their personal accountability within the scope of professional competence. Ethical and legal obligations The professional Code of ethics for Nurses and Midwives in Tanzania of 2007 requires all practitioners to conduct themselves and practice within moral and ethical framework based fundamentally upon respect for the well-being of patients and clients. Respect for individuals and communities All members of the profession must demonstrate an inviolable respect for persons and communities, without prejudice, and irrespective of orientation and personal, group, political, cultural, ethnic or religious characteristics. Uses of standards of proficiency 1. Reflecting the values and priorities of nursing profession and midwifery 2. Providing direction for nursing and midwifery practice 3. Providing framework for the evaluation of nursing and midwifery practice 4. Defining the nursing profession s and midwifery s accountability and the client outcomes for which nurses and midwives are responsible 10
SECTION ONE STANDARDS OF PROFESSIONAL PERFORMANCE PERTAINING TO NURSING PRACTICE Introduction In this section the standards of proficiency define the overarching principles of being able to practice as a nurse, the context in which they are achieved and defines the scope of professional practice. In addition, the nurse performs professional duties in accordance to his/her core professional functions that include; (i) promotion of health and wellness of individuals, families, groups, community and supporting agencies by encouraging them practice healthy life styles, (ii) prevention of ill health (disease) to individuals, families groups and community at large to maintain optimal health, (iii) alleviation of suffering through managing the patient to restore health, and (iv) comforting empathetically the dying individuals regardless of their ages so as to have a peaceful death and assist the deserted cope with the death. Furthermore, nursing service is guided by defined rules and regulations, policies and codes of ethics. Therefore, the nurse entering to the nurses part of the register have to achieve the standards of proficiency in the practice of the nurse s job description, education, expertise in provision of care, and adherence to the individual institutional policies and procedures Standard Indicator Measurement criteria/guidance The nurses Job Aspect of general responsibilities Caregiver description The nurse carries out a number of Plans nursing care for individuated to a patient functions and roles concurrently, Provides physical, social, cultural, developmental and spiritual care directly and not necessarily one after or indirectly to completely or partially dependent patients another Evaluates nursing care outcomes Communicator The nurse identifies patient problems and provides care then communicate such problems and outcomes of the interventions to the patient Records appropriately the patient problems and care provided and keep them confidentially and safely Delivers patient problems and care provided clearly and accurately either 11
verbally or in writing to other members of the health team or/and to the health system Teacher Helps clients learn about their health and health care procedures they need to perform aimed at restoring or maintaining or promoting their health Learns language, learning needs, developmental levels and culture preferences of patients, families and community Deliver preventive and supportive health education messages to patients, individual clients, families, societies, and communities Prepares and presents health information to scientific conferences and public meetings Seeks feedback of session conducted and methods used to convey health message Client advocate The nurse represents the needs and wishes of the client to other health professionals, supporting agents and significant others involves in patients welfare Assist patients to exercise their rights Promote patients to speak up for themselves Counselor The nurse encourages a client to look at alternative behaviours against stressful environments Assist the patient recognize choices and develop sense of control towards stressful emotional, intellectual, psychological, social or spiritual problems the client face Change agent The nurses make constructive changes, in the health facility and in the health care system at large Assist clients to make modifications in their own behaviours Leader The nurse influences individuals, families, groups, community and colleagues in the health care system to work together to accomplish a specific goal 12
Aspect of specific responsibilities a) The registered nurse The registered nurse undertakes care independent but in collaboration with other member of the health care team and system Understands the needs and goals that motivate individuals, families, groups and communities Applies leadership and the interpersonal skills that to influence others Manager The nurse manages the care of individuals, families, groups and communities The nurse is fully aware of institute s organizational structure, dynamics, authority and accountability, leadership, advocacy, delegation, supervision evaluation and collaboration with other health care team members Patient manager The nurse ensures that care is oriented to the client, patient management plans focus to expected outcomes The nurse ensures that costs reflect to amount of care given Work with others in the health care system to measure effectiveness of patient management plans Monitors implementation of nursing care plan and the intervention outcomes Research consumer The nurse understands language and research process, sensitive to issues related to protecting rights of human subjects, active in participating research projects and great consumer of research findings Uses research to improve patient care Resource utilization Evaluates factors and impact on practice when selecting practice options that would result in the same expected outcomes Assists the patient and family in accessing appropriate health facility and services to meet their health needs or solve their health problems The nurse uses health and client resources wisely Manages oneself, one s practice, and that of others, in accordance with the TNMC code of professional conduct: recognizing one s own abilities and limitations. Practices in accordance with an ethical and legal framework which ensures the primacy of patient and client interest and well-being, and respects confidentiality 13
Acknowledges the differences in beliefs and cultural practices of individuals or groups in a fair and anti-discriminatory way, Creates and utilizes opportunities to promote the health and well-being of patients, clients and communities. Engages in developing and disengaging from therapeutic relationships through the use of appropriate communication and interpersonal skills. Undertakes and document a comprehensive, systematic and accurate nursing and midwifery assessment of the physical, psychological, social and spiritual needs of patients, clients and communities. Formulates and documents a plan of nursing care, where possible in partnership with patients, clients, their careers and family and friends, based on informed consent. Applies knowledge and an appropriate range of skills indicative of safe nursing practice basing on the best available evidence Provides a rationale for the nursing care delivered which takes account of social, cultural, spiritual, legal, political and economic influences. Evaluates and document the outcomes of nursing and other interventions. Encourages critical, creative and reflective thinking as well as sound clinical judgment across a range of differing professional and care delivery contexts. Contributes to public protection by creating and maintaining a safe environment of care through the use of quality assurance and risk management strategies. Advocates for knowledge of effective inter-professional working practices which respect and utilize the contributions of members of the health and social care team. Delegates duties to others, as appropriate, ensure that they are supervised and monitored. Enhances knowledge, skills, values and attitudes needed for safe and effective nursing practices professional development and personal supervision activities in order to. Enhances the professional development and safe practice of others 14
through peer support leadership, supervision and teaching. Conducts research that contribute towards enhancement of nursing profession, as well as health and social wellbeing of individuals, families and community Contributes to the development and evaluation of guidelines and policies and make recommendations for change in the interests of nursing. Contributes to the teaching and learning processes of approved curriculum in class, clinical and community settings The nurse understands social forces that in past and currently influence nursing profession and affect the health care system in its totality The nurse s education b) The enrolled nurse The enroled nurse undertakes care independent but in collaboration with other member of the health care team and system The nurse attains knowledge and competences that reflect current nursing practice Assists in carrying out comprehensive observation of the patient and help in assessing their care requirements Assists in the implementation of nursing care under the direction of Registered Nurses Accepts delegated nursing tasks Assists in reviewing the effectiveness of the care provided Assists in communicating results of care provided Assists in keeping and retrieving effectively patients records of care provided Work in collaboration with other health care team members in providing care to patients. Participates in coaching students during clinical learning Identifies own learning needs through self-reflection and inquiry Participates in ongoing educational activities pertaining to knowledge bases and issues of the profession Keeps well groomed on knowledge, skills and attitudes appropriate to the nursing practice, settings, roles, or situations through reading and learning Maintains professional records (portfolio or curriculum vitae) that provide evidence of competency and knowledge Makes consultations pertaining to experience, formal and informal learning activities in order to maintain and develop clinical and professional attitudes, 15
The nurse s expertise in provision of care Aspect of nursing practice The nurse provides comprehensive, evidence based and individualized nursing care to patients skills and knowledge Expand clinical knowledge, enhance role performance, increase knowledge of professional issues through use of current health care research findings and other evidences Preparations The nurse correctly and appropriately prepares the patient, self, colleagues, supplies, equipment, and environment prior to performing the procedures The nurse involves patient, family members, support agents available and significant others in the preparation of the patient to undergo a procedure Assessment The nurse systematically collects patient subjective and objective health data Uses appropriate evidence based assessment techniques and tools in collecting desired data Involves the patient, family and other health care team members in a holistic data collection activity Prioritizes data collection activities basing on patient health status or condition Analysis Sorts out and clusters data collected realistically Initiates and interprets problems of the patient correctly Determines patients actual and potential needs and their possible etiologies Diagnosis The nurse derives nursing diagnoses or issues based on the assessment In cooperates patient, family and other health care providers in the process of validating the data Determine the expected outcomes Outcome identification The nurse identifies without doubt expected outcomes or objective of care individualized to the patient The nurse involves the patient, family and other health care providers as appropriate Writes expected outcomes from the nursing diagnoses basing on current 16
Aspect of professional scientific evidences and hospital opted nursing theory Changes expected outcomes as are appropriately due Planning The nurse proposes a plan of care that prescribes nursing specific interventions to attain the expected outcomes The nurse proposes a plan that reflect current rules and regulations as well as standards pertinent to nursing profession Considers time and impact of cost the plan as well as possibilities of continuity of care as appropriate Develops individualized nursing care plan basing on patients condition and wishes of the patient, family as well as other health care providers Implementation The nurse Establish constructive relationships and communicate effectively with patients, groups, clients and/or communities that is appropriate to their different backgrounds in order to address their needs and preferences The nurse employs without harm to the patient the nursing interventions proposed in the plan of care Implements the nursing care plan comfortably, and in a safe and timely manner Involves other colleagues in the implementation of the plan The nurse demonstrate the ability to communicate health issues and polices that affect the patient Evaluation The nurse evaluates the patient progress towards attainment of expected outcomes or objective of care The nurses revises nursing interventions in accordance with results of evaluation data and identifies further outcomes Record keeping The nurse documents accurately and completely the care delivered to the patient The nurse keeps safely and confidentially all assessments and care delivered Quality care 17
performance The nurse promotes the quality and effectiveness of care in practice The nurse systematically evaluates the quality and effectiveness of nursing and midwifery practice Demonstrates highly skilled analytical ability and transfer of concepts, principles and theories to and in a completely new situation Applies professional ethic standards of nursing including confidentiality, informed consent, avoidance of practice errors, and avoidance of conflicts of interest among patients, patient s family, colleagues Apply entrepreneurial skills for advancement of personal practice and the profession Advocate and implement fair distribution of health care resources all nursing service consumers at all settings Recognize own practice abilities and limitations, and knowing when to request assistance. Performance appraisal The nurse evaluates his/her own nursing or midwifery practice in relation to nursing and midwifery practice standards, relevant guidelines and professional regulations Conducts appropriately performance appraisal in motivating staff Education The nurse acquires and maintains contemporary knowledge of nursing and midwifery practice Applies knowledge of attitudinal standards while interacting with patients, clients, communities and health professionals, and in all aspects of nursing practice, specifically on competence, honesty, integrity, compassion, informed consent, truth telling, justice and respect for others, as well as professional and social responsibilities The nurse shows to be highly keen on sensitivity and responsiveness to culture, age, socioeconomic status, gender, religion, and disability within individuals, families groups and communities Collegiality The nurse interacts with and contributes to the professional development of colleagues, and other health care providers Encourages qualified nursing and non-nursing professionals to count 18
themselves as appropriate resource and important individuals in the health care system Demonstrates the ability to use communication skills and take advice from colleagues Motivate colleagues Contribute effectively to teamwork. Work effectively with other health professionals Ethics The nurse appropriately make decisions and actions on behalf of the patients are determined in an ethical manner Describe the implications of basic ethical principles, including confidentiality, informed consent, truth telling, and justice, for the care of patients Reports timely all illegal, incompetent, and malpractice to the appropriate authority Collaboration The nurse collaborates with the patient, family, and other health care providers in providing patient care The nurse records all plans of care information, rationales for changes of plan of care, their implications when changes are mismanaged and communicate these in collaborative discussions Demonstrates knowledge of how the health care system functions including structures, policies, regulations, standards and guidelines Participates appropriately in strengthening health services in various health care delivery settings and systems including hospitals, government, ministries, No s, communities, industry Coordinate and implement health service delivery and health interventions within the health care system Promotes quality care in health care system through quality audits, accreditations, and/or evaluations The nurse identifies strengths, challenges, threats and opportunities, and errors with the system, and suggest and implement potential solutions 19
Encourages qualified nursing and non-nursing professionals to count themselves as appropriate resource for students of health sciences Participates incorporating of cost effectiveness and patient cost burden into health service delivery and into the health care system Aspect of health teaching The nurse provides clear, accurate and health education to client, patient, members of family, employers and significant others involved in the care Kills Research The nurse participates in research activities as appropriate to level of education and position Uses research findings in guiding decisions and practice Resource utilization The nurse considers factors related to safety, effectiveness and cost in planning, delivering patient care delivering, and monitoring The nurse applies knowledge and skills of entrepreneurial for advancement of practice and the profession Leadership The nurse demonstrates management skills in the provision of nursing care and the profession itself Preparations The nurse involves family members or other support partners who are involved in the caring for the patient The nurse prepares himself/herself on the session, materials and equipment and the room Assessment The nurse determines the condition of the client readiness for a teaching session The nurse collects data pertaining to client s learning strengths and deficits Learning needs identification The nurse transforms assessment data into meaningful learning needs and problems of the client, patient, members of family, employers and significant others involved in the care Educational diagnoses 20
The nurse recognizes educational diagnoses of the client from assessment data The nurse plans with client, patient, members of family, employers and significant others involved in the care on educational problems identified and their possible solutions Planning For a teaching session The nurse prepares teaching plans o Writes appropriate learning outcomes o Selects accurate content o Determines appropriate teaching strategies and materials o Determines time frame for delivering the content The nurse plans in advance for contents that need consultation Implementation (i)in a teaching session The nurse provides health education that focuses to topics of interest to the patient Uses teaching strategies that are realistic to the audience and related to health education topic Provides opportunities for the audience to express their feelings and understanding from the session to draw immediate feedback (ii)in a provision of care The nurse discusses with the patient on the procedures of care Instruct patient on the procedure and reasons of having such procedures, their frequency and time The nurse instructs patient concerning restrictions or precautions that need to taken before or after the procedure Evaluation The nurse evaluates client/patient learning basing on achievement of learning outcomes through checking questions Involves the patient, family members and other health care providers in determining number and level of achievement of the education expected outcomes 21
Adherence to the individual institutional policies Adherence to the institutional procedures Aspect of legal issues The nurse provides care that is within the legal boundaries of his/her practice Aspect of professional ethics Demonstrates high ethical standards in all aspects of nursing practice, specifically competence, honesty, integrity, compassion, respect for others, professional responsibility and social responsibility The nurse performs procedures that are within the boundaries of his/her practice The nurse re-plan nursing teaching as appropriate and due Demonstrate knowledge and understanding of legislation, and common law that have implication to nursing practice Responds to acts and breaches of law relating to nursing practice Identifies unsafe practices and takes appropriate actions to ensure safe delivery of care and expected outcome Identifies rights of both consumer and provider of health services in terms of appropriate notification and opportunity to hearing of concerns, and decisions base on principle of being fair, objective, cosistance and nondiscriminatory The nurse practices in accordance to code of professional ethics The nurse maintains patient confidentiality within legal regulatory parameters The nurse acts as a patient advocate and provides assistance in developing skills so that they can advocate for themselves The nurse delivers nursing care in a nonjudgmental and nondiscriminatory manner that is sensitive to patient diversity The nurse delivers care in a manner that preserves patient autonomy, dignity, and rights The nurse seeks available resources in formulating and implementing ethical decisions The nurse s decisions and actions on behalf of the patient are determined in an ethical manner The nurse familiarizes with their professional responsibilities described by the agency or institution The nurse or midwife ensures that he/she upgrades his/her education and experiences to accommodate the responsibilities prescribed in the job descriptions The nurse protects client from harm by anticipating sources of client injury, educating clients on hazards and implementing measures to prevent injury to clients The nurse involves the client in making decisions at every step of care 22
The nurse assesses and monitors client s care appropriately The nurse approaches every client with sincere concern and include the client in conversations to prevent from acts of negligence claims The nurse appreciates professional boundaries and admits when they do not know the answers to clients questions The nurse performs procedures that are within the legal boundaries of nursing and midwifery practice The nurse involves the family members and other significant support people who care for the patient The nurse provides client education that will ensure the client s safe transition from one level of the care to another The nurses provides health education and make plans for follow up education in the client s home or nearby health facility 23
Introduction SECTION TWO STANDARDS OF PROFESSIONAL PERFORMANCE PERTAINING TO NURSING EDUCATION This section provides the standards for nursing and midwifery education programme, in accordance with, Section 6 (D) of the Act No 1 of 2010 The Nursing and Midwifery Act, which requires the TNMC to from time to time establish standards of proficiency necessary to be admitted to different parts of the register or roll In addition, this section provides the standards and guidance that contribute to the knowledge base of nursing as well as direction to nursing practice, education management and the ongoing research activities. Therefore, this section is entirely describing standards related to length of programme; nature of the programme; structure of programme; concepts, principles and theories underpinning practice; teaching in the classroom and clinical settings; assessment of student performance; and programme monitoring and evaluation Standard Indicator Measurement criteria/guidance The programme The nursing education programme has sufficient resources that enable students achieve cognitive, affective and psychomotor competences as defined by TNMC Has background information that indicates its historical development There is description of justification of the programme existence There are outstanding programme intent including vision, mission (purpose), aims, goals (major assignments), philosophy and learning outcome statements, ethics and procedures (training rules and regulations) There is evidence of short and long term forecast of the demand for nursing education programme graduates in quantitative terms There is well defined pool of potential students for enrolment into the 24
programme There is detailed explanation of competences that they would be graduate possess There is an organization chart which demonstrates academic and operational leadership as well as lines of authority and relationship among the nursing education programme, other education institutions, health care institutions, collaborative partners and significant others There are detailed description of information, communication and technology equipment and sessions to optimize teaching and learning There is description of all committees, boards, councils and associations whose decisions affect the continued operations of the nursing education There are reliable sources of funds to meet short and long term demand for operations of the institution There are adequate and reliable buildings with furniture to meet where applicable to meet boarding and lodging services for students There are adequate and reliable buildings There is document indicating student enrolment including number and type of students, transfer in and out, dropouts, discontinued and graduation (admission, progression and graduation) There are well defined physical plants for transport, energy and sources of clean and safe water supplies There are well equipped sources of teaching activities and learning experiences proximal to the students; including classrooms, offices, library, skills lab, wards, clinics, homes and villages where students will meet competences There measures outlined to ensure the safety of students, tutors and clients at all times There are comprehensive and firm plans for recruitment and retention of qualified staff, and staff development There is good supply of teaching materials and equipment for teaching and learning activities Description of supporting agencies to the programme, students and 25
By nature of the programme, its graduates achieve the minimum competences for license to practice as defined by TNMC staff There is description of general functions and specific responsibilities as well as career prospects of the would be graduate Decision made on transfer of credit: Provides students with opportunities to step on and off programme using appropriate AP (E) L processes where it is necessary Balance of theory and practice: Provides sufficient length of placements that are not less than 1/2 theory and 1/ practice in both Common Foundation Courses and programme specific courses to enable students achieve the competences Teaching and learning strategies: Constitutes a variety of participatory approaches including use of skills lab practice, simulation and direct patient care for developing required competencies in a student Academic standard of programme: As a minimum, nursing education programme culminates in the award of a certificate, diploma, and bachelors or higher levels of nursing profession and nursing education. Awarding: Prior to graduation, ensures all the academic requirements and student evaluations are complete and provide evidence that the desired competences and learning outcomes for an approved nursing educational institution are met Scope of the curriculum: Ensures that the depth and breadth of the learning experiences is sufficient enough to enable students to achieve proficiency for safe and effective practice. 26
Qualities of teaching staff : Ensures that teachers and clinical instructors or mentors or preceptors in nursing educational institutions posses concepts, principles and theories of teaching and learning methodologies to support effectively the teaching and learning processes Acceptance of the graduate to practice Ensures that the graduate meet the nursing standards and minimum competences acquired during internship performance as evidenced by self evaluations and internship instructor within six months of completing the nursing education programme The programme clearly describe policies and procedures related to students, which are congruent to operations of the educational institution Quality of graduate performance Ensures that trends in the graduate performance on the licensure examination approved by TNMC are identified, and takes action when graduate performance falls below the agreed pass mark There are published policies, procedures, laws and regulations in the educational institution and are known by the students, staff, parents and significant others There are policies, procedures, laws and regulations in the educational institution but not limited to: o Admission requirement specific to the nursing education programme o Criteria and selection procedures of the most suitable applicant to join the institution o Information pertaining to graduation, withdraw, probation and failure to progress with the programme o Student appeals grievances and discipline o Ethical and moral treatment of the student There are policies, procedures, laws and regulations in the educational institution (where applicable) pertaining to admission to the programme of mature students 27
The curriculum The curriculum is clearly described and its foundation are congruent with achievements of competences and TNMC standards of practice The curriculum content provides the learning experiences necessary for the student to desired professional competences as defined by TNMC There are pertinent student records and reports pertaining to: o Classroom and clinical hours attended o Course grades o Assignments and projects fulfilled o Tests and examinations done o Other information permitted under the relevant legislation There are clear explanation of general examination regulations and clear programme structure and organization There are clear explanation of training regulations and disciplinary codes of pertaining to defaulters of the regulations There are policies, procedures, laws and regulations in the educational institution pertaining to regulating access to students records that ensure the confidentiality and privacy of these records Indicates location of all theory and practice modules There is description of programme delivery systems such as by semester, block and term, or by distributed learning systems such as units or modules Indicates description of breaks including breathers, annual leave, public holidays and local institutes events Indicates hours and credits per module Indicates hours and credits per total programme There is congruence among philosophy, conceptual framework, and the curriculum Provide statements of programme competence descriptors, principle, enabling and sub-enabling outcomes and their related tasks The desired programme outcomes are clearly included and are consistence with standards defined by TNMC The curriculum intent, content and scope are responsible to and reflect to needs and problems affecting health and wellness of individuals, families, groups, and communities; legal and ethical considerations affecting nursing profession; health service delivery; education, leadership and research in nursing; evidence based nursing care; 28
diversity in client populations; and others The competences in the curriculum and categories of TNMC standards (scope of practice, professional standards and practice standards are systematically introduced in the modules theory and practice at one level of period of study are built upon at another module or level The programme structure consider appropriate Explains dates when the programme enrollment/registration and termination/graduation organization of learning Curriculum organization, modules and their descriptions and learning experiences outcomes are organized basing on principles of logical continuity, sequence and integration Indicates that theoretical and technical instruction modules constitute to 70% of the curriculum (nursing science 35%, basic sciences 20% and social sciences carry15%), while clinical instruction (clinical practice) modules constitute 30 % as evidenced by number of credits The hours are considerably split and allocated for classroom, skills lab, and clinical learning outcomes to enable student to meet programme outcomes Includes learning experiences and activities that surround the must know orbit Evidenced to have time realistic in accomplishing delivery of contents and their activities at each stage of learning Teaching and learning strategies are consistence with the philosophy, conceptual framework, and desired learning outcomes The content are broken down into manageable steps for the learners, ensuring that it is meaningful, related to the learning outcomes stated, and the teachers existing knowledge there is evidence of using criteria for content selection for the programme, including o Knowledge (facts, information, concepts, and theories ect) o Skills (step-by-step procedures, conditions and requirements) o Attitudinal factors (values, appreciations and interest) The faculty The faculty size and composition Selection of teaching staff bases on teaching methodology expertise, 29
characteristics is sufficient to provide teaching and guidance to students to ensure students progress towards attainment of competences as defined by TNMC clinical expertise, teaching ability, as well as research and scholarly activities Number full-time qualified nurse tutors is 8 for certificate programme, 12 for diploma programme and 18 or more degree programme, parttime and guest lecturers The faculty posses the theoretical knowledge, skills lab instruction and clinical expertise appropriate to their instructional responsibilities Demonstrates that only nurse teachers facilitate theoretical and technical instruction instructions of nursing science modules in the nursing education programme Describe the system and mechanism that verify the teachers in the nursing education programme are all registered members of the TNMC Teachers have abilities in o Providing, nursing care to clients requiring outpatient nursing care, medical intensive nursing care, o Preparing frameworks, outcomes and competences o Preparing plans of work and implementation plans for activities of a given institution o Developing and planning various curricula particularly content based curricula, integrated curricula, and competence based curricula o Designing and developing training/education materials o Planning teaching and learning experiences including curriculum, curriculum cum rotation plans, course plans, lesson plans and lesson notes o Facilitating learning to students of various health disciples utilizing appropriate principles of teaching, methods of teaching, teaching/facilitation skills, and steps in conducting a teaching session o Setting test and examination items/questions and their marking schemes o Preparing, using, and keeping, safely different clinical and 30
Entry requirements for admission Aspect of educational background Approved educational institutions ensures that applicants for registration in education programme has provided evidence of basic minimum entry requirements classroom performance assessment tools o Conduct student performance assessment at various learning levels and disciplines in health sciences o Supervising, monitoring and evaluating students, staff and academic programme o Conducting research and utilizing effectively research findings o Conducting guidance and counseling sessions to the students colleagues and significant others o Preparing and giving feedbacks to student and colleague performance and following counseling sessions o Leading, managing and administering health care and educational institutions including human, money, material, time and space resources o Developing strategic plans o Preparing manuals and other documents related to health issues There are approved policies and procedures for discipline, termination from duty and grievance pertinent to staff There is document of rules and regulation including ethical treatment of teaching staff There are laid down plans for staff movement and professional development plans Certificate Program Ordinary level of secondary education with Pass in Science subjects i.e Biology, Chemistry, and either Physics or Mathematics. A pass in English is an added advantage Diploma Program 2.1 Pre - service Ordinary Level of secondary education with credits in Biology and Chemistry and one pass from either, Physics or Mathematics. A pass in English and or evidence of Advanced Level of secondary education is an added advantage 2. Diploma Program 31
2.1 Pre service Ordinary Level of secondary education with credits in Biology and Chemistry and one pass from either, Physics or Mathematics. A pass in English and or evidence of Advanced Level of secondary education is an added advantage 2.2 In-service Passed certificate programme with B grade Enrolled and Licensed to practice with TNMC Working experience not less than two years Delivery of certificate of Ordinary level of secondary education indicating Pass in Biology, Chemistry, and one from either Physics or Mathematics Aspect of health of the applicant Applicants must demonstrate that they have good physical and mental health and good character For these completed nursing program before 2010 one must have Ordinary secondary level education with one pass science subject either Biology or Chemistry Degree Program 3.1 Pre-service Advanced Secondary level Education with passes in science subjects i.e Biology Chemistry. Physics or Mathematics and other criteria set by academic regulatory authority 3.2 In service Passes with B grade in Nursing or other health related Diploma programme Registered and Licensed to practice with TNMC Working experience of not less than two years Delivery of certificate of Ordinary level of secondary education indicating Pass in Biology, Chemistry, and one from either Physics or Mathematics Physically and mentally fit for nursing education and practice as evidenced by self-assessment, health questionnaires, routine health screening, occupational health assessment, Criminal Record Checks 32
at admission, during and on completion of nursing education program and subsequently practice as a nurse and other measures agreed between the programme providers. Personal attributes that are typically in line with professional code of conduct as evidenced by character references and self-declaration of good character. Declaration of any conviction or caution related to criminal offences that they might hold. Fulfillment of other criteria set by academic regulatory authority The Council will permit accreditation of prior learning against any part of the programme where the applicant is able to demonstrate relevant prior learning to the satisfaction of the approved educational institutions and in accordance with the Council s requirements and guidance on AP(E)L. i) Length of programme: A student may undertake a shorter programme of education where credit is given by an approved educational institution for previous academic or experiential learning. The Council has determined that this may, normally, be to a maximum of one-third of the normal length of the programme. Accreditation of prior (experiential) learning (AP (E) L) may be awarded provided that, through a combination of study and AP(E)L, the student meets all of the requirements and standards of proficiency that Council may from time to time determine ii) Award of credit: The TNMC recognizes that approved educational institutions will have processes in place that comply with their internal policies and academic regulatory authorities. The TNMC requires that such processes, where necessary, be developed, to include a mapping process of how prior learning meets TNMC outcomes and standards of proficiency. Processes will be approved by the TNMC as part of programme approval, and monitored through TNMC on quality assurance processes in relation to programme leading to registration with the TNMC. Such an award of credit must be supported by verifiable evidence, mapped against the outcomes and standards of proficiency of the pre-registration nursing programme. The Council requires robust quality assurance processes 33