Advanced Programme in Nurse Anaesthesia Programme description

The Advanced Programme in Nurse Anaesthesia is based on the national curriculum for further education in nurse anaesthesia and the regulations relating to the national curriculum for further education in nurse anaesthesia adopted by the Ministry of Education and Research on 1 December 2005 and meets the requirements stipulated in these documents. The programme has a scope of 90 credits, and is taken as a full-time course of study over one and a half years. After completing the programme, the students will have action competence in the field of nurse anaesthesia; see the requirements set out in the national curriculum for further education in nurse anaesthesia with pertaining regulations.

Nurse anaesthesia

Nurse anaesthesia consists of practising nursing and anaesthesiology activities in connection with surgery, procedures and examinations and in acute situations in and outside a hospital setting. Nurse anaesthesia is a form of independent professional practice that takes place in close collaboration with other members of the healthcare team, in particular anaesthetists. The anaesthesiology activities are delegated by a doctor. Anaesthesiology work comprises general and regional anaesthesia and observing patients under e.g. sedation. Many of the patients are moved from a familiar environment into a hospital ward characterised by high-tech equipment, many personnel groups with clearly defined functions and a high degree of efficiency. The patient target group comprises people of all ages who:

• are admitted for planned surgery or examination
• have suffered an injury/accident
• suffer acute illness
• experience an acute exacerbation of a long-term illness
• are in a condition where their vital functions are threatened or failing
• end up in a state of physical, mental, social and/or existential crisis due to the illness they experience
• need pain relief due to acute and/or chronic illness

All these groups of patients can have additional diseases or conditions that also require the special expertise of a nurse anaesthetist.

Relevance to working life

The Advanced Programme in Nurse Anaesthesia is intended to help to cover society¿s increasing need for specialist nursing skills, primarily in the specialist health service, but also in the municipal health service.

Nurse anaesthetists are in high demand, as they are key personnel in the specialist health service when it comes to providing professionally sound healthcare to acutely and critically ill patients. The specialist health service seeks nurse anaesthetists who practise their profession in a sound manner and on a scientific basis. Today, we can treat many diseases and injuries that could not be treated in the past. Also, the patients admitted to somatic hospitals are sicker than they used to be. This development makes new and stricter requirements of nurse anaesthetists. Society requires intensive nurse anaesthetists to work in an evidence-based manner where their nursing practice is based on knowledge gained from research and experience, in addition to patient knowledge. Nurse anaesthetists shall be capable of analysing and taking a critical approach to existing theories and methods in advanced medical treatment and nurse anaesthesia. Moreover, they shall be able to contribute to new ideas and innovation processes in their own practice, and make independent use of relevant methods for quality-related work (professional development, quality assurance or quality control work) in the field of nurse anaesthesia. Nurse anaesthetists are qualified to take greater responsibility for evidence-based nurse anaesthesia in relation to acutely and/or critically ill patients in and outside a hospital setting.

In hospitals, nurse anaesthetists work in anaesthesia departments, surgical departments, postoperative units, accident and emergency departments, examination and treatment rooms, pain clinics and radiology departments. The nurse anaesthetist plays an important role in prehospital work, call-outs and transport of acutely and/or critically ill patients. Other potential workplaces are enterprises that require a high degree of emergency preparedness and the ability to work independently in acute situations, for example in offshore activities. Traditionally, nurse anaesthetists have also engaged in different forms of international aid work.

The municipal health service is also experiencing a growing need for specialist nursing skills. The Act relating to Municipal Health and Care Services, etc. (the Health and Care Services Act) has given the municipalities a greater role in the treatment of acute-onset illness, exacerbation of chronic illness and in follow-up care for patients whose hospital treatment is finished. Therefore, nurse anaesthetists will also be in demand in the municipal health service. The Norwegian Association of Nurse Anesthetists describes the special function and role of nurse anaesthetists in its code of ethics, standards of practice, monitoring and education for nurse anaesthetists (¿Grunnlagsdokument for anestesisykepleiere¿) (https://www.alnsf.no/alnsf/grunnlagsdokument).

After completing the Master¿s Programme in Nurse Anaesthesia, candidates will have action competence in the field of nurse anaesthesia, but will also be qualified to initiate and implement development projects and participate in research work within their own organisation. Candidates are qualified to take greater responsibility for evidence-based nurse anaesthesia in relation to acutely and/or critically ill patients in and outside a hospital setting.

Relevance to further studies

The Advanced Programme is identical to the first three semesters of the Master¿s Programme in Nurse Anaesthesia at OsloMet ¿ Oslo Metropolitan University. Students who complete the Advanced Programme in Intensive Care Nursing in accordance with this programme description, will only have to write the master¿s thesis to be awarded the degree of Master of Nurse Anaesthesia, provided that they meet the admission requirements for the master's degree programme.

The target group for the programme is authorised general nurses who would like to work as nurse anaesthetists ¿ primarily in the specialist health service, but also in treatment of conditions for which pain relief or anaesthesia is required in the municipal health service.

Admission to the programme is in accordance with the Regulations relating to Admission to Studies at OsloMet ¿ Oslo Metropolitan University and the national curriculum for further education in nurse anaesthesia with pertaining regulations, adopted by the Ministry of Education and Research on 1 December 2005.

The academic basis for admission to the programme is a three-year bachelor's degree in nursing or equivalent. Applicants must also hold a Norwegian authorisation as a general nurse and have at least two years¿ somatic nursing experience from the specialist health service after receiving their authorisation (including pre-hospital work).

Additional points (maximum 1,5 points) are awarded for all higher education beyond the minimum requirement.

Additional points (maximum 2,5 points) are awarded for all relevant work experience beyond the minimum requirement. By relevant work experience is meant experience as a nurse from postoperative/intensive care units, medical intensive care units, intermediate care units in the specialist health service, emergency care departments or similar.

Twenty-five per cent of places on the programme are reserved for students who compete for admission on the basis of their grade point average alone.

Applicants who are admitted to the programme must submit a transcript of police records, cf. the Regulations for admission to higher education Chapter 6.

The use of clothing that covers the face is incompatible with taking the programme.

After completing the Advanced Programme in Nurse Anaesthesia, the candidate is expected to have achieved the following overall learning outcomes defined in terms of knowledge, skills and competence:

Knowledge

The candidate

• has advanced knowledge of the nurse anaesthetist's functions and areas of responsibility
• has advanced knowledge of anaesthesiology and emergency medicine
• has advanced knowledge of complications in connection with acute and critical illness, anaesthesiology, sedation and analgesia
• has advanced knowledge of how to maintain and restore vital functions if they are threatened
• has in-depth knowledge of the experiences, reactions and needs of patients and next of kin in connection with acute and/or critical illness in an age-related and multicultural perspective
• has knowledge of scientific theory and research methods
• is capable of analysing problems in nurse anaesthesia on the basis of the discipline's history, traditions, distinctive nature and place in society

Skills

The candidate

• is capable of analysing and taking a critical approach to different sources of information and of using them to structure and formulate nurse anaesthesia argumentation
• is capable of applying knowledge in new areas and new situations in nurse anaesthesia
• is capable of applying relevant knowledge in relation to patients and next of kin from different cultures
• is capable of independent work on theoretical and practical problem-solving relating to the functions and responsibilities of nurse anaesthetists
• is capable of maintaining and restoring vital functions in patients if they are compromised
• is capable of carrying out observations, monitoring and clinical assessments in connection with acute and/or critical illness, anaesthesia, sedation and analgesia
• is capable of preventing complications in connection with acute and/or critical illness, advanced medical treatment and nurse anaesthesia
• is capable of reducing stress, pain and discomfort in connection with surgical treatment and examinations
• is capable of practising nurse anaesthesia in accordance with ethical principles and healthcare legislation.

Competence

The candidate

• has action competence in the field of nurse anaesthesia
• is capable of analysing relevant ethical issues in nurse anaesthesia based on discipline knowledge, research, experience and patient knowledge
• is capable of applying his/her knowledge and skills to new fields to carry out advanced tasks and projects in nurse anaesthesia
• is capable of communicating extensive independent work and masters the forms of expression used in nurse anaesthesia
• is capable of applying pedagogical and subject didactics principles when informing, teaching and providing guidance to patients and caregivers from different cultures, as well as to colleagues and other members of the healthcare team
• is capable of communicating about issues, analyses and conclusions in nurse anaesthesia, both with specialists and with the general public
• is capable of processing his/her own reactions in connection with the work and helping co-workers/colleagues deal with their experiences and reactions
• is capable of taking a critical approach to the possibilities and limitations of technology
• is capable of multidisciplinary and interdisciplinary cooperation in patient treatment
• is capable of planning, organising, coordinating and cooperating on the available resources to ensure that they are used in a targeted manner in the patient's best interests
• is capable of contributing to new ideas and innovation processes in professional practice

The programme comprises 8 compulsory courses, which make up a total of 90 credits. Theoretical studies make up 45 credits, while clinical training accounts for 45 credits. The programme is taken as a full-time course of study over a period of one and a half years.

National curriculum for further education in nurse anaesthesia

In order to ensure that students who complete the Advanced Programme in Nurse Anaesthesia are qualified to work as nurse anaesthetists, the programme meets the requirements set out in the national curriculum for further education in nurse anaesthesia with pertaining regulations adopted by the Ministry of Education and Research on 1 December 2005, both in terms of content and the breakdown of credits.

Progress requirements

• All coursework requirements in a course must be met before a student can take the exam.
• Students must have passed ABIO6000 Natural Science related to Nursing in order to take the exam in ANEST6000 Anaesthesiology
• Students must have passed ANESTPRA10 Clinical Studies in Nurse Anaesthesia, Level 1 in order to start ANESTPRA20 Clinical Studies in Nurse Anaesthesia, Level 2.
• Students must have passed ANESTPRA20 Clinical Studies in Nurse Anaesthesia, Level 2 in order to start ANESTPRA3 Clinical Studies in Nurse Anaesthesia, Level 3.

The work and teaching methods used in the programme are based on a sociocultural perspective on learning. This means that the student participates in and contributes to a learning community where fellow students, lecturers and others are important to his/her learning. The goal of the work methods is to encourage independence, fresh thinking, own activity and reflection. Feedback, formative (continuous) assessment and supervision will be the learning community¿s key activities to advance learning. Learning is considered a process that involves the whole person and is manifested through the change in the person learning.

Study methods that promote evidence-based practice are used throughout the programme in that the student integrates knowledge from research and experience and patient knowledge.

The programme emphasises student-active methods intended to encourage the students to actively seek relevant and reliable sources of knowledge. The process will alternate between individual work and interaction with fellow students and others in group work, seminars, simulations and practical training.

Lectures

Lectures are primarily used to introduce new subject matter, give an overview and highlight main elements and links between different topics, and also to communicate relevant issues. The lectures in the three common courses for several of our advanced nursing programmes will be held as joint lectures, but joint lectures will also be used in other courses. Most lectures are held in a Scandinavian language, but they can also take place in English.

Group work

Group work, is used as a teaching method to encourage cooperation between students, support the learning of subject matter and provide training in cooperation and interaction skills, which are necessary skills in professional practice.

Seminars

Seminars, are held in which students present assignments they have been working on and receive oral feedback from their fellow students and lecturers. The purpose of the seminars is to stimulate each other¿s learning process, clarify students' own understanding of the subject and develop cooperation skills. The students are given the opportunity to practise their academic formulation skills, and academic discussions between students and lecturers are facilitated.

Teaching/providing guidance to patients and/or fellow students

During the programme, preferably in the third semester, the student will conduct a teaching session for fellow students/colleagues or provide guidance to a patient, for example delivering preoperative information.

Self-studyNot all topics are covered by organised teaching activities, and students are expected to acquire knowledge of the remaining topics through self-study. Students come to this programme with different preconditions for learning, and self-study enables them to prioritise topics and areas they want to focus on. Self-study also helps to encourage independent activity and reflection.

Simulation

Simulation, which is compulsory attendance, is used to practise procedures and become familiar with equipment and machines. Simulation is also used to gain teamwork experience and skills in relation to rarely occurring and life-threatening situations, particularly complex situations that require prompt and appropriate action. Simulator training allows students to pause in situations that require reflection in action. After having had the chance to reflect on their own actions, students can repeat the situation in order to become better prepared to act.

Practical trainingPractical training, which is compulsory attendance, is an important work method in the programme. See a more detailed description in the chapter on practical training.

The field of practice is an important qualification arena for developing action competence in nurse anaesthesia and evidence-based practice. Professionally sound intensive nurse anaesthesia practice must be learned in direct interaction with patients. This is the only way in which students can gain experience and encounter challenges of sufficient complexity to allow them to achieve the programme¿s learning outcomes. When nursing acutely and/or critically ill patients, decisions must often be made quickly, and through practical training, students acquire the practical experience needed to develop an immediate understanding of the patients¿ situation and the knowledge and action required.

Practical training in the programme is organised as three courses. When calculating the practical training, we assume that 5 days in practice is a week. Theory and / or study days are not included in the calculation of scope out in practice.The practical training must make up no less than 50% and no more than 60% of the programme, and at least 90% of the practical training must involve patient contact; see the requirements set out in the national curriculum for further education in nurse anaesthesia.

Clinical Studies in Nurse Anaesthesia

First semester: ANESTPRA10, 20 credits (13 weeks ¿ about 65 days of practical training)Second semester: ANESTPRA2020, 15 credits (10 weeks ¿ about 50 days of practical training)Third semester: ANESTPRA3, 10 credits (7 weeks ¿ about 35 days of practical training)

The practical training is organised such that on completion of the programme, the student will have gained experience of and developed nurse anaesthesia action competence in relation to all common conditions, important forms of treatment and different patient situations.

The practical training must include specialist departments where the patient¿s vital functions are threatened or failing. Students will primarily undergo clinical training in units that perform:

• vascular and thoracic surgery
• gastrointestinal surgery
• urological surgery
• orthopaedic surgery
• ear, nose and throat surgery
• obstetrics and gynaecological surgery
• postoperative monitoring

SupervisionPractical training will be supervised, and the student is guaranteed supervision by a nurse with advanced training or a master's degree in nurse anaesthesia.

Specification of learning outcomes

In the course of the first two or three weeks of each clinical training course, the students must specify the learning outcomes for the course in relation to their own preconditions for learning and the framework at the department where the course is taken. This must be approved by their clinical training supervisor and lecturer. These learning outcome descriptions must be concrete, relevant, realistic and measurable. They must describe observable behaviour, for example actions, performance or skills, or results of an unobservable mental behaviour such as a change in attitude. They are intended to help to clarify what the student needs to learn and which learning situations are required to achieve this. This provides a direction for the supervision/instruction required and indications for use in the assessment. The students will receive supervision from their practical training supervisor and lecturer during the specification process.

Compulsory attendance at practical training

Attendance is compulsory in areas that are important for achieving action competence as a nurse anaesthetist and where the student cannot acquire knowledge through self-study. This means that attendance is compulsory during practical training courses, which makes up approx. 32 hours per week. In order to pass a practical training course, the student must have attended at least 90% of the planned activities in each course. Students must make up for absence exceeding 10% by agreement with the lecturer and the practical training establishment. If a student¿s absence exceeds 20%, he/she will fail the course. Absence is calculated on the basis of the programme overview/practical training plan for each course.

Elective practical trainingStudents have the opportunity to organise a total of 1¿5 weeks of elective practical training in the course of the programme. The elective practical training must be taken at hospital departments that are relevant to the functions of a nurse anaesthetist, either one of those listed above or another relevant department. The student must contact the practical training establishment him/herself and submit a written application for elective practical training for the university¿s approval. Only students who have passed all their exams so far in the programme and are not at risk of failing a practical training assessment can be granted such approval.

OsloMet ¿ Oslo Metropolitan University has established cooperation with universities and university colleges in and outside Europe, and is a member of different academic networks. Students can apply to take parts of the programme abroad, preferably at institutions that OsloMet cooperates with. Students who wish to go on exchanges at other institutions will have to organise the exchange themselves and obtain the university's approval.

It is primarily the practical training courses in the second and third semesters that are suitable for exchanges. Only students who have passed all their exams so far in the programme and are not at risk of failing a practical training assessment can take these courses abroad. Written submissions beyond this, presence and academic strength will also be part of the assessment for the student that the student can travel on exchange.

The programme uses guest lecturers from foreign partner institutions, and the programme's own lecturers gain knowledge and experience through exchanges with the same institutions.

Required coursework is all types of work and tests that are conditions for being permitted to take the exam. In this programme, the required coursework comprises:

• written assignments
• documentation of literature selected by the student
• teaching/providing guidance to patients and/or fellow students
• specification of learning outcomes for clinical courses

The main purpose of coursework requirements is to promote the students¿ progress and academic development in the programme, stimulate students to seek out and acquire new knowledge, and facilitate cooperation and communication in relation to professional issues.

FeedbackThe students receive written and/or verbal feedback from the lecturer and/or fellow students on their written assignments based on the criteria of relevance, theoretical knowledge, in-depth study, ethical reflection, independence and how the assignment is presented (see Assessment of written work in the Assessment chapter of the programme description).

ApprovalRequired coursework is assessed as approved/not approved. Required coursework that is not approved must be improved before re-submission. If the work is not approved on re-submission, the student cannot take the ordinary exam. Students are entitled to a third attempt before the resit/rescheduled exam. If the third attempt at a coursework requirement is not approved, the student cannot take the resit/rescheduled exam and will have to wait until the ordinary exam for the following year. The student will then be entitled to three new attempts with the new class.

Students will encounter different forms of assessment during the programme. The forms of assessment are intended to ensure a continuous process towards a twofold objective: to promote learning and document the competence achieved by the students as sufficient in relation to the applicable learning outcomes. By giving the student qualified and frequent feedback in relation to both processes and products, the information about the competence achieved can motivate the student¿s further efforts and show whether the forms of learning should be adjusted.

Each course concludes with a summative assessment. The assessment is based on the learning outcomes for the course, and what is assessed is whether the student has achieved the stipulated learning outcomes.

The assessments are carried out in accordance with the Act relating to Universities and University Colleges, the Regulations relating to Studies and Examinations at OsloMet, and the Guidelines for Appointment and Use of Examiners.

AssessmentThe grades used are pass/fail or a grade scale with letter grades from A to F, where A is the highest grade, E is the lowest pass grade and F is a fail. In connection with group exams, all students in the group are awarded the same grade.

Resits/rescheduled exams

Resit and rescheduled exams are carried out in the same manner as the ordinary exam unless otherwise specified in the course description. In special cases, resit and rescheduled exams in courses with group exams may be held as individual exams.

Appeals against grades

Grades awarded for written exams can be appealed. It is not possible to appeal the grades awarded for oral and practical exams. In connection with a group exam, the result of an appeal will only have consequences for the candidate(s) who submitted the appeal. The other students will keep their original grade.

Assessment of written work

Written work, such as the required coursework and exam papers for AABIO6100 and ANEST6100 is assessed on the basis of the criteria of relevance, theoretical knowledge, in-depth study, ethical reflection, independence and how the work is presented.

Relevance:                                     

The work must have a frame of reference that is relevant to the discipline and show that the student has applied theoretical and practical knowledge of relevance to the issue at hand. It must be linked to the nurse anaesthetist's functions and areas of responsibility.

Theoretical knowledge:           

The work must demonstrate knowledge in the independent and delegated functions of the nurse anaesthetist nurse (medicine). It must contain relevant documentation from the course literature and other relevant literature and research.

In-depth study:                            

The student must elaborate on and discuss different factors that have an effect on the issue at hand and discuss how the knowledge produced can be applied in a clinical setting. Experience from practical work and literature should be used as a basis for discussing the assignment. The work must answer the issue in question.

Ethical reflection:                        

Ethical factors relating to the issue must be discussed.

Independence:                             

The work must demonstrate independent assessment, and its content must be objective, critical and analytical with discussions of positions and claims.

How the work is presented:  

The assignment must be well-organised with good written presentation, clear and unambiguous language with use of specialised terminology, and adhere to the prescribed structure and form.

Students are only entitled to feedback if their work is completed within the deadline stipulated.

Assessment of practical training

Students are subject to formativeassessment (continuous assessment) on a continuous basis throughout all the practical training courses. The assessment is intended to provide advice and guidance by determining progress, helping to improve strengths and drawing attention to areas the student needs to continue to work on. It should take account of the student's preconditions for learning, framework conditions at the practical training establishment, the learning outcomes in the course, the student¿s specification of the learning outcomes and the content of the supervision.

Both the student and the practical training supervisor shall prepare written assessments for each clinical course: 

• The practical training supervisor must submit written assessments of the student from days or periods of supervision.

Students are expected to show progress through the practical training courses. The student is expected to demonstrate clear progress, take responsibility and, to an increasing extent, demonstrate the ability to make independent analyses and assessments in nurse anaesthesia practice. The requirement for an increasing degree of independence is expressed in the learning outcomes through the use of the expressions ¿under supervision¿, ¿with some supervision¿ and ¿independently¿. The progress in the student¿s learning is also manifested in the expectation that students should master an increasing number of areas in nurse anaesthesia. On completion of the final practical training course, Clinical Studies in nurse anaesthesia, Level 3, the student is expected to have achieved nurse anaesthesia action competence.

The summative assessment (product assessment) takes place at the end of each practical training course. The assessments are based on the learning outcomes for the course, the student's specification of the learning outcomes and the formative assessment made of the student during the course. The purpose of these assessments is to:

• check that the student has achieved the learning outcomes for the course
• discuss the possibilities and limitations that the student has encountered at the practical training establishment
• clarify strengths and weaknesses and the changes that have to be made in order for the student to achieve the learning outcomes when a student has failed the course

The lecturer plans the assessments together with the practical training supervisor. The student writes his/her own assessment based on the programme¿s assessment form. This assessment, together with the assessments from the lecturer and the practical training supervisor, forms the basis for the decision on whether or not the student has passed the clinical course. Students who fail a period of practical training must retake the whole training period.

External programme supervisor

An external programme supervisor scheme exists for the programme. The duties of the external programme supervisor are to:

• supervise the standard of the results in the programme compared with the standard of the results in comparative programmes
• assess the connections between the programme description's learning outcomes, teaching and types of assessment
• give the academic environments/faculties feedback and advice that can be used in the ongoing work on programme quality.

The reading list totals approx. 6,000 pages, of which approx. 1,000 pages are chosen by the student. The syllabus selected by the students should be related to the in-depth assignment and the written assignments that make up the required coursework (1,000 pages).