Usability of Standards for Scaffolding in a Health Sciences Programme: A feasibility Study

BACKGROUND

Standards contribute to comprehensive and programmatic implementation of educational strategies, such as scaffolding. Although the development of educational standards follows a rigorous consensus approach, they are socially constructed and could result in varied interpretations by users. Reports of varied implementation of standards in health professions education underscore the need to test the developed standards for scaffolding in health sciences programmes. Usability entails determining whether a product like standards works as intended under the expected conditions and contexts. This study aimed to describe the usability of standards for scaffolding in a health sciences programme through a pilot study.

METHODS

A multi-method design employing user and expert-based usability evaluation techniques sought to describe the usability of the standards for scaffolding in a three-year pre-registration nursing programme. The user sample of nurse educators drawn from the programme, conducted a self-assessment on scaffolding practices in the programme using a developed standards checklist. For the expert sample, three-panel members with an understanding of the discipline and programme context were purposively sampled. These panelists studied the users' self-assessment reports before completing an author-generated heuristics checklist to support or refute any of the standards. Descriptive statistics, comparative and content analysis were applied to analyse data from users' interviews and expert's completed heuristics checklist, determining the standards' usability, and identifying the usability flaws or strengths.

RESULTS

The users had three or more years of teaching experience in the competency-based curriculum for nursing. The experts shared an average of 16 years of experience in teaching in higher education, and seven years of experience in quality assurance and programme accreditation. The four standards had a usability score of above average (68%). Seven usability strengths and four usability flaws were identified. Usability flaws related to misinterpretation of some criteria statements and terminologies, multiple meanings, and users' challenges in generating evidence for some criteria.

CONCLUSIONS

The pilot study revealed the context-based 'truth' regarding the fidelity of a health sciences programme evaluation on scaffolding, as well as identifying the ideal contextual conditions in which the standards for scaffolding health sciences programmes would work best. The identified usability flaws highlighted the need for further revisions of the standards. Future research on the feasibility of the standards in other health sciences programmes and contexts is recommended.

Twelve tips for creating online learning units for the health professions in low-and middle-income countries

Health professions educators in low-and middle-income countries are often sceptical about developing online learning units. This scepticism stems from the belief that online programmes are limited in developing clinical competence, and there are concerns about digital proficiency and resource availability. A social constructivist approach in designing online work-based learning units may overcome such scepticism. In this article, we use our experience in developing an online learning unit for healthcare education to suggest 12 tips for developing online learning units in a low-and middle-income context. The tips are nested in a 'promoting theory-practice integration framework' and include context, establishing communities of learning and practice, establishing foundational knowledge, practise in a work-based environment, and showcasing attainment of learning outcomes. By integrating the guidelines and framework, healthcare educators will be better equipped to develop online learning units and contribute to learning.

Mindfulness-based interventions to support wellbeing of adults in low socio-economic settings: a realist review

BACKGROUND

Mindfulness as a modality involves training the innate human capacity for present-moment awareness with a view to cultivating a more harmonious and integrated life experience, especially in the face of hardship. Over the past four decades, the field of mindfulness has grown rapidly. Despite a substantial body of literature outlining the many benefits of mindfulness practice within a range of contexts and populations, the authors noticed that studies addressing the adaptation, application and value of mindfulness-based interventions (MBIs) for adults within socio-economically challenged setting were scant. To address this gap, we conducted a realist review of studies pertaining to MBIs within low socio-economic settings, to determine the extend and nature of research in this sector and culminating in a program theory which may be useful for the design of interventions going forward.

METHODS

We selected realist review as the methodology as it is well suited to investigating the complex nature of social interventions. The value of realist review is that the exploration of the causal relationships between the mechanisms (M) within a specific context (C) towards particular outcomes (O) offers a deeper understanding of the intervention which may assist in more effective delivery going forward. The review follows the guidelines presented by the Realist and Meta-narrative Evidence Synthesis - Evolving Standards project.

RESULTS

Of the 112 documents identified, 12 articles met the inclusion criteria. Of these 12 studies, 10 were conducted in the United States, with little representation across the rest of the globe. The interventions described in these articles were varied. We identified mechanisms that offered beneficial outcomes for participants across a range of contexts, with indications of how interventions might be adapted towards greater accessibility, acceptability, and feasibility within communities.

CONCLUSION

By reviewing the various programs in their respective contexts, we developed a program theory for implementing socio-culturally adapted MBIs in low socio-economic settings. In the future, this program theory could be tested as a means to create a sense of wellbeing for people living in low socio-economic settings.

Doctoral Contribution to Nursing Science in Sub-Saharan Africa: A Document Review

Nursing science is at serious risk of extinction. The lack of funding for research, absence of healthcare policies underpinned by nursing science, and general lack of understanding of nursing metaparadigms all contribute to the stunted growth in nursing science. Doctoral research is a platform for the development and refinement of nursing science. The purpose of this qualitative retrospective document review was to describe the doctoral contribution to nursing in sub-Saharan Africa (SSA). Electronic dissertations for doctoral degrees in nursing within a 5-year period from universities in SSA were included. The extracted data comprising the purpose of the studies, the models used in the studies, and the studies' contributions to nursing science were analyzed against a knowledge contribution framework. In total, 166 documents were included, mostly from South African universities, with a predominant focus on developing models, frameworks, and strategies within nursing practice. Only 17% of the studies applied grand nursing theories or models, with the rest of the studies applying theories from other disciplines. The contribution to nursing science from the doctoral studies was poor. The low uptake of nursing models in doctoral research in SSA may significantly contribute to the lack of refinement of nursing science within SSA. Structured approaches focused on integrating the nursing metaparadigms, theories, and models and fundamental underpins for doctoral education in Africa are essential to influencing the refinement of nursing science.

Educators' ability to use concept mapping as a tool to facilitate meaningful learning

Background: Meaningful learning is enhanced when concepts are visually differentiated, linked to or nested under other concepts, resulting in integrative reconciliation of knowledge and understanding. Competence in using concept mapping as a strategy to support students towards meaningful learning, is essential.Aim: The aim of the study was to describe the nature of the concept maps drawn by educators after a symposium on concept maps to transfer educational knowledge to the classroom.Design: A quantitative descriptive cross-sectional design was used to explore the nature of concept maps drawn by educators after having attended a workshop on concept mapping.Methods: The authors developed a checklist based on the principles of a good concept map to assess and describe to what extent the concept maps drawn by the participants, aligned with general principles on creating a concept map appropriate to enhance meaningful learning. During a symposium, participants were introduced to the advantages, principles and requirements for concept mapping. Sixty-two (62; 100%) participants drew concept maps. Using a checklist based on the principles of good concept mapping, we assessed concept maps from 22 (35.4%) volunteers to explore the extent to which the concept maps aligned with general principles necessary to enhance meaningful learning.Results: Criteria for a good concept map include the graphical presentation and establishing relationships between these concepts. The network-style concept map was used by the majority (68%) of the participants. Only 9% used the spoke concept map. The graphical presentation of concepts and the relationships between these was limited. Only 41% of the maps were understandable, while 36% made sense in the context of the chosen topic.Conclusions: Well-designed concept maps can add value to and improve educator teaching and student learning. Not all educators in this study understood what a good concept map is. Visualisation offered by concept maps assist in recognising how new knowledge can link with, and build on, existing knowledge.

A concept analysis on the transfer climate in health sciences education

The transfer of learning is complex, with factors such as transfer climate influencing students' transfer of learning. This transfer climate will shape a student's experiences during work-integrated learning and can be modified to enhance the transfer of learning. However, studies on transfer climate are mainly reported from a human resource development context and the outcomes may not be transferable to health sciences education. Furthermore, there is no uniformity in defining and measuring transfer climate. Rodgers' evolutionary concept analysis approach was used to describe the antecedents, attributes, and consequences of a positive transfer climate. An information specialist assisted in developing a Boolean search string and searched 15 databases to identify relevant sources. In total, 156 relevant articles were selected from 1448 sources. Data were charted and thematically analyzed. Antecedents comprise interpersonal relationships and theory-practice correlation. The presence of student support, training programs, student characteristics, clinical facilitator characteristics and a well-resourced clinical environment are the attributes of a positive transfer climate and act as learning transfer mediators. Transfer climate consequently influences student, educational, and organizational performance. A conceptual definition for transfer climate was then proposed. It was subsequently concluded that developing competent healthcare professionals and providing support to students depend on the synergy and good working relationship between health services and educational institutions. The insights into modifiable elements to enhance transfer climate could benefit health sciences educators in reconsidering their clinical training models to ensure sufficient support during students' clinical placements to meet the demands for a better-qualified healthcare workforce.

Health sciences educator's simulation debriefing practice needs: A mixed methods study

BACKGROUND

Simulation debriefing influences learning from healthcare simulation activities. Health sciences educators must be competent in conducting simulation debriefing for healthcare students. A structured faculty development intervention for health sciences educators must be informed by educator needs to enhance its utility. This paper describes the needs of health sciences educators regarding simulation debriefing at a faculty of health sciences.

MATERIALS AND METHODS

A parallel convergent mixed methods study design was applied on a selected population of 30 health sciences educators at the University (x) who integrate immersive simulation for first- to final-year students in their undergraduate programs. The Objective Structured Assessment of Debriefing tool underpinned observations which informed the quantitative strand of the study, while semi-structured interviews were conducted as part of the qualitative strand. Descriptive statistics and thematic analysis were used to analyze the data.

RESULTS

Health sciences educators struggled to establish the learning environment for simulation (median 1), facilitate learning (median 3), and evaluate their debriefing activities. However, they were able to apply an appropriate approach toward simulation (median 4). They identified the need to be educated on the fundamentals of simulation-based education.

CONCLUSION

A continuing professional development program must be developed aimed at transforming approaches toward facilitating learning, explaining the fundamentals of simulation-based education, modeling of best-practices related to debriefing, and applying appropriate strategies for evaluating debriefing activities.

Scaffolding in Health Sciences Education Programmes: An Integrative Review

The complexity of health sciences programmes justifies scaffolding to support students in becoming competent health professionals. This article reports on an integrative review that aimed to describe the application of scaffolding in health sciences programmes. Twenty-nine sources, inclusive of theoretical and empirical studies, were reviewed. The sequencing of educational activities, the application of scaffolding tools or resources, frameworks for applying scaffolding, modelling, and fading represented the application of scaffolding in health sciences programmes. Awareness of the application of scaffolding in health sciences programmes could contribute to enhancing competence development among students when applied across all learning platforms.

Standards for Scaffolding in Health Sciences Programmes: A Delphi Consensus Study

Introduction

Health sciences programmes operate in complex, unpredictable contexts, underscoring the need for comprehensive scaffolding of the learning processes. Yet, the scaffolding approaches remain fragmented, and lack a shared approach to how programmes could integrate scaffolding across the curricula. The literature argues that standards result in the comprehensive implementation of educational practices. There are no reported standards related to scaffolding practices in these programmes.

OBJECTIVES

To develop standards for scaffolding in health sciences programmes utilising a consensus approach through a modified Delphi Technique.

METHODS

Following the recommendations on Conducting and REporting of DElphi Studies (CREDES), an online modified Delphi technique was applied. Evidence on the application of scaffolding in health sciences programmes, obtained through an integrative review, was synthesised to draft standards. Using purposive and snowball sampling, an international panel from diverse geographical and professional backgrounds refined and validated the standards. Descriptive statistics was utilised to analyse demographic data and consensus agreements to include standards and criteria. Qualitative analysis of textual comments ensured the synthesis and inclusion of critical divergent views and additions.

RESULTS

A total of 22 experts from around the globe agreed to participate in the study and one did not complete Delphi surveys. Most experts (n = 18) held a PhD; and an average of 19 years of teaching in health sciences programmes. Four standards and 27 criteria were included after achieving consensus during the two Delphi surveys rounds. The included standards focused on four areas: structuring and sequencing educational activities, resources/tools for scaffolding, structuring the programme and instructional strategies to support learning.

CONCLUSION

The principle-based standards developed in this study could direct and support scaffolding practices in health sciences programmes. The standards' emphases on macro-, meso- and micro-scaffolding present numerous opportunities for designing and applying contextually sensitive scaffolding strategies at every level of curriculum implementation.

A supportive clinical learning environment for undergraduate students in health sciences: An integrative review

BACKGROUND

The clinical learning environment is a platform where theory and practice should be integrated in a safe environment. However, many students experience the clinical learning environment as "stress provoking", because this environment is not always supportive.

OBJECTIVE

The aim of the article is to report on a study that synthesized the evidence on strategies for providing a supportive clinical learning environment for undergraduate students in health sciences.

DESIGN

The integrative review followed the methodology of Whittemore and Knafl (2005).

DATA SOURCES AND REVIEW METHODS

We searched MEDLINE with Full Text, CINAHL with Full Text, Academic Search Ultimate, PsycINFO, Health Source: Nursing/Academic Edition, ERIC, Africa-Wide Information, OpenDissertations, CAB Abstracts, MasterFILE Premier, SocINDEX with Full Text, SPORTDiscus with Full Text and PsycARTICLES. Other data sources included grey literature and reference lists. The filtering process, quality appraisal and data extraction were carried out by at least two independent reviewers. Thematic analysis was used to analyse the data.

RESULTS

The search yielded 500 studies, of which nine studies met the inclusion criteria. The generated data culminated in a clinical learning environment mindmap that highlights, firstly, a network of carefully selected supporters who may have specific clinical responsibilities while supporting undergraduate students in clinical learning. Secondly, the relationship between the student, student supporter and clinical staff should create a sense of belonging, self-efficacy and self-directedness. This relationship is influenced by the roster, the ratio of students to student supporters, and appropriate learning opportunities. Thirdly, higher education institutions and healthcare providers should support students and student supporters through formal partnerships.

CONCLUSIONS

The synthesis of the evidence provided new insights regarding creating and maintaining supportive clinical learning environment strategies for undergraduate students in health sciences. These strategies may be implemented in innovative ways to provide students with the best clinical learning opportunities.

Clinical placement models for undergraduate health professions students: a scoping review

BACKGROUND

Clinical learning is fundamental to undergraduate health professions students. There are several calls for the transformation of health professions education, which have direct implications on clinical learning. Clinical placement models provide structure to clinical learning. Therefore, this scoping review could contribute to supporting curriculum transformation to enhance learning in the clinical environments for undergraduate health professions students.

OBJECTIVES

This scoping review identified the characteristics of research evidence related to mapping the purpose, methodologies used, outcomes, and specific recommendations associated with clinical placement models in undergraduate health professions education.

DESIGN

A scoping review method was used in this study. A search string developed from the title of the review was used to search online databases to identify research published between January 2000 and March 2020.

RESULTS

Forty-eight articles reporting on ten clinical placement models were included in this review. The majority of these articles originated from Australia and predominantly report on nursing. The aims of these articles aligned with the evaluation of the implementation of a clinical placement model. Seven categories of outcomes of the clinical placement models are reported namely, relationships, influence, environment, facilitation, inputs, knowledge scores, and student perceptions.

CONCLUSIONS

As clinical learning is fundamental to undergraduate health professions education, clinical placement models should prioritise the development of competence among undergraduate students. Insights into outcomes reported in literature could guide educators in fostering optimal learning in students who may then be able to influence community health outcomes positively.

Development of a conceptual framework for a Person-centred Nurse Residency Programme

Newly Qualified Professional Nurses (NQPNs) require support while transitioning from student to professional nurse. Nurse residency programmes guided by competent facilitators provide such support. We developed a conceptual framework for a Person-centred Nurse Residency Programme. This qualitative interpretive descriptive study was conducted in three phases. In phase 1, we assessed the support needs of purposively selected NQPNs as well as senior professional nurses. Data were collected using multiple methods and analysed during a consensus workshop held in Phase 2. In Phase 3, we developed a conceptual framework which was validated by six nurse education experts. The final framework comprised of four domains: learning outcomes, learning processes, learning environment, prerequisites of the facilitator, and was underpinned by the educational theories of constructivism and person-centeredness. Advocates of nurse residency programmes should recognise that these domains are interrelated and aim to achieve person-centred support for NQPNs.

Towards Continuing Interprofessional Education: Interaction patterns of health professionals in a resource-limited setting

There are challenges related to collaboration among health professionals in resource-limited settings. Continuing Interprofessional Education initiatives grounded on workplace dynamics, structure and the prevailing attitudes and biases of targeted health professionals may be a vehicle to develop collaboration among health professionals. Workplace dynamics are revealed as health professionals interact. We argue that insights into the interaction patterns of health professionals in the workplace could provide guidance for improving the design and value of CIPE initiative. The study was conducted through rapid ethnography and data were collected from non-participant observations. The data were transcribed and analysed through an inductive iterative process. Appropriate ethical principles were applied throughout the study. Three themes emerged namely “Formed professional identities influencing interprofessional interaction”, “Diversity in communication networks and approaches” and “Professional practice and care in resource limited contexts”. This study revealed poor interaction patterns among health professionals within the workplace. These poor interaction patterns were catalyzed by the pervasive professional hierarchy, the protracted health professional shortages, limited understanding of professional roles and the lack of a common language of communication among the health professionals. Several recommendations were made regarding the design and development of Continuing Interprofessional Education initiatives for resource-limited settings.

Stakeholders' perceptions of family-centred care in the intensive care unit: An associative group analysis

AIM

To explore different stakeholders' including nurses, health care professionals and family member's perceptions of ideal family-centred care in an intensive care unit.

RESEARCH DESIGN AND METHODS

We used a mixed method approach to identify perceptions of family-centred care with 60 stakeholders of equal numbers who voluntarily participated in the study. Data were collected over one month using an associative group analysis method. The responses were ranked, scored, thematically themed and weighted.

SETTING

A 23 bed adult intensive care unit in an urban private hospital in South Africa.

FINDINGS

According to the stakeholders' responses, ideal family-centred care should be built around communication based on expectations and engagement. In addition, the physical environment should allow for overall comfort and spiritual care must be incorporated.

CONCLUSION

Stakeholders had similar perceptions on the main themes however; nuances of different perspectives were identified showing some of the complexities related to family-centred care. Spiritual care was highlighted by the family members, revealing the need to broaden the care perspectives of healthcare providers.

Optimising simulation learning experiences for mature, postgraduate nursing students

Mature students do not always approach learning activities according to expected adult learner behaviour. In addition, they may have never experienced simulation as a learning opportunity before. This creates a unique opportunity for nurse educators to contextualise education principles that are most applicable to mature students' learning needs. Education action research was conducted with two groups of mature postgraduate students, using nominal and focus groups to optimise their simulation learning experiences. Results showed that mature students should be thoroughly oriented beforehand about simulation practice and what is expected of them during participation. Through scaffolding and a succession of at least six to 10 simulation sessions, learner independence and adult learner behaviour can be developed. Begin with less complex scenarios before moving to ones that are more complex - this will prevent cognitive overload. Keeping the simulation environment as authentic and reliable as possible will promote suspension of disbelief. A non-punitive debriefing model is essential for enhancing student engagement and motivating improved performance in follow-up simulation learning sessions. If nurse educators stay open and responsive to the learning needs of mature students, the advantages of learning through simulation can be realised fully.

Social norms as possible causes of stillbirths

OBJECTIVE

High stillborn rates are a concern in developing countries. Hence, this article aims to describe the sociocultural norms contributing to the high number of stillbirths as perceived by mothers, significant others, midwives and records of the Pregnancy Problem Identification Programme (PPIP).

DESIGN & SETTING

A multimethod qualitative descriptive study was conducted in a district in the Free State, South Africa. Each of the five sub-districts has a district hospital where most pregnant women give birth. Eighty per cent of the community is black of which about a quarter live in poor conditions below the poverty line.

PARTICIPANTS

The first author conducted unstructured in-depth interviews with 36 mothers and their significant other who gave birth to a stillborn. She also extracted relevant data from the PPIP record of each mother. A skilled moderator conducted three focus group interviews with a convenience sample of midwives. The data were inductively analysed to identify subthemes under the central theme of social norms.

KEY CONCLUSIONS

The authors concluded that traditional practices, traditional role players (traditional healer, mother-in-law, partner), abuse, and prescriptive social norms might contribute to stillbirths. Pregnant women are oppressed as they adhere to traditional social norms and are unable to make independent, informed healthcare decisions. The midwives, who are mostly female, may find it difficult to empower pregnant women because they are under the same social oppression as their clients.

IMPLICATIONS FOR PRACTICE

It is imperative that healthcare providers consider social determinants of health, including social norms, when providing healthcare, especially to pregnant women as some social practices may have detrimental outcomes for the mother and/or baby.

The Ears of a Hippopotamus: Quality of Venous Leg Ulcer Care in Gauteng, South Africa

OBJECTIVE

To describe venous ulcer care and wound care practices in Gauteng, a province of South Africa, according to the Donabedian structure-process-outcome quality improvement model.

METHODS

Forty-eight facilities were selected randomly from public and private wound care practices in Gauteng. Structured interviews were conducted with care providers via questionnaire to assess the structural aspects of the Donabedian model. Within these facilities, investigators randomly selected 160 patient files and extracted data using a checklist to assess processes implemented and outcomes reached for patients who had previously presented with lower-leg venous ulcers.

RESULTS

Facilities lack the necessary equipment to perform vital assessments. Handheld Dopplers were available in 66% (n = 48) of the facilities. Sixty-one percent (n = 48) of the personnel at the facilities indicated that they had no formal wound care training. Although the majority of files (92%, n = 147) indicated that an assessment tool was used, many elements were not evaluated comprehensively according to the best available evidence. Aspects such as smoking, body mass index, and anemia were assessed in fewer than 30% of the patients. Distinguishing between superficial and deep infection and the accompanying overuse of antimicrobials and antibiotics were among the challenges identified. Further, 71% of patients received compression therapy, although the ankle-brachial pressure index of only 30% of patients was known. In 27 cases (17%), the outcome was amputation.

CONCLUSIONS

From this survey, it is evident that not all clinicians providing wound care in Gauteng are adequately trained or fully implementing best practice guidelines, and the consequences are detrimental to patients, particularly in terms of amputation. This article highlights the need for improved legislation and regulation for practitioners who deliver wound care services.

Students' perceptions of interprofessional education and collaborative practice: analysis of freehand drawings

There is a global shortage of healthcare professionals, but in the social economic environment of Africa workforce numbers are lower than the global average per head of population. It is argued that interprofessional and collaborative care may offer a solution to this problem, and therefore interprofessional education has become a requirement for accreditation. This paper reports on an innovative initiative of a South African university, which implemented four two-hour education sessions of which the two middle sessions were simulated with standardised patients. The 28 interprofessional student groups each created a freehand drawing of their perception of collaborative practice during the fourth and final session. Four out of the 28 images were randomly selected and analysed according to specified steps by three researchers using qualitative methods. Seven themes emerged, which identify the characteristics and principles of collaborative practice and suggest that culture plays an important role. The findings also reveal the tensions arising from the difficult and uphill battle to attain collaborative practice due to silo based training models, multidisciplinary care, and fragmented healthcare services. Educational planners may need to consider the challenges of implementation of the theory of IPE into the real world of practice as well as how to overcome the hidden cultural issues that may impede success.

Looking beneath the surface of a preceptor-training programme through a realist evaluation

South Africa's department of health devoted themselves to the clinical nursing education and training model, which indorses preceptors as essential stakeholders to promote competence in students. A preceptor-training programme was developed that build on this model and implemented through an intervention. The initial programme theory hypothesised that trained preceptors would promote support and develop competence in students in comparison to untrained preceptors. Results showed a poor outcome because few preceptors participated and a high student attrition rates. The authors then posed the question "Why did the preceptorship training programme not work?" This article offers insight into the context, mechanism, and outcome of the preceptor-training programme through a realist evaluation. Reflective field notes, gathered during the intervention, were used and gave insight regarding how, for whom, and under which circumstances the programme could work and offered a refined programme theory for preceptorship. The main conclusion drawn showed that a preceptor-training programme alone is not the sole determining factor to ensure preceptors' motivation to transfer their learning; a systems approach, ensuring the effectiveness of the programme, should be followed. Reflection on findings indicated the implementation context as a major determining factor of the training programme.

Monitoring preceptors' supportive role: A measuring instrument for increased accountability

PURPOSE

This article describes the development of a measuring instrument to monitor support offered by preceptors during their accompaniment of students in clinical facilities.

DESIGN

A quantitative methodological study design was used to develop the instrument.

METHODS

Data were collected by means of a self-completed questionnaire. Total sampling of 192 undergraduate nursing students was done. Descriptive data analysis was conducted regarding the biographical characteristics, Cronbach's alpha was computed to determine the reliability, and an exploratory factor analysis was done to describe the construct validity of the developed instrument.

RESULTS

The Cronbach's alpha of 0.98 indicates high reliability and high internal consistency. Three constructs regarding clinical support, namely cognitive-, emotional- and system support were identified by means of the exploratory factor analysis.

CONCLUSION

The new conceptualisation of support gives insight into the value of the preceptor's role. The instrument designed for this study could be used to assess and monitor the support offered by preceptors while they accompany students in clinical practice.

CLINICAL RELEVANCE

Considering the need to strengthen nursing and midwifery education systems, this instrument contributes to measuring and monitoring clinical accompaniment of students by preceptors.

A creative analysis of the role of practice development facilitators in a critical care environment

Practice development focuses on methods to address the quality of care and advance healthcare practices. The role of practice development facilitators to address challenges of delivering evidence-based person-centred care in the critical care environment was determined by using a nominal group technique. Eleven participants from public and private healthcare services reached consensus on seven clusters: theory-practice application, facilitation of learning, increasing collaboration, effective communication, facilitation of change, time management and role modelling. The clusters were visually represented as a hot air balloon. Competence as facilitators is of vital importance to ensure knowledge translation with the aim to improve quality.

Scholarship in nursing: Degree-prepared nurses versus diploma-prepared nurses

Background: The nursing profession needs nurses with a higher level of education and not merely more nurses to enhance patient outcomes. To improve quality patient care the nursing discipline needs to be advanced through theory development and knowledge generation, thus graduate nurses. Nursing scholarship cannot be limited to nurse academics, but is the responsibility of every nurse. Although the world is looking towards combating the decline in nursing numbers with better educated nurses, South Africa is planning to address the problem with more lower qualified nurses.Aim: The aim of this study being reported here was to establish whether degree-prepared nurses in South-Africa partake more often in scholarly activities than diploma-prepared nurses.Method: A cross-sectional descriptive design was used. The population was all professional nurses registered with the South African Nursing Council who obtained either a four year degree or four year diploma in nursing. Data were gathered from 479 respondents, using aself-administrative questionnaire.Results: Three times more nursing educators (n = 19) achieved a degree as first qualification than their colleagues (n = 6) who achieved a diploma as first qualification. All but one (n = 18) nursing educators who obtained a degree as first qualification are educators in the private sector that include both universities as well as nursing colleges of private hospital groups. Data further revealed that most nurse educators and those in managerial positions were degree prepared. More degree prepared nurses than diploma prepared nurses were actively involved in scholarly activities such as research (30,5% compared to 25,5%) andimplementing best practice guidelines (62,2% compared to 55,9%).Conclusion: The global nursing crisis, nor the nursing profession, will benefit by only training more nurses. The profession and the health care sector need more degree prepared nurses to improve scholarship in nursing.

Bridging the gap between self-directed learning of nurse educators and effective student support

Background

Self-directed learning requires the ability to identify one’s own learning needs, develop and implement a plan to gain knowledge and to monitor one’s own progress. A life-long learning approach cannot be forced, since it is in essence an internally driven process. Nurse educators can, however, act as role models to empower their students to become independent learners by modelling their own self-directed learning and applying a number of techniques in supporting their students in becoming ready for self-directed learning.

Objectives

The aim of the article is to describe the manifestations and implications of the gap between self-directed learning readiness of nurse educators and educational trends in supporting students.

Method

An instrumental case study design was used to gain insight into the manifestations and implications of self-directed learning of nurse educators. Based on the authentic foci of various critical incidents and literature, data were collected and constructed into a fictitious case. The authors then deductively analysed the case by using the literature on self-directed learning readiness as departure point. Four constructs of self-directed learning were identified, namely internal motivation, planning and implementation, self-monitoring and interpersonal communication. Supportive strategies were identified from the available literature.

Results

Nine responses by nurse educators based on the fictitious case were analysed. Analysis showed that readiness for self-directed learning in terms of the identified constructs was interrelated and not mutually exclusive of one other.

Conclusion

The success of lifelong learning is the ability to engage in self-directed learning which requires openness to learning opportunities, good self-concept, taking initiative and illustrating independence in learning. Conscientiousness, an informed acceptance of a responsibility for one’s own learning and creativity, is vital to one’s future orientation towards goal-directed learning. Knowledge and understanding of one’s own and students’ self-directed learning abilities are critical for nurse educators. In the nursing profession, it has been shown that self-directed learning by the nurse educators has a direct relationship towards the development of a lifelong learning approach by their students. Supporting students towards becoming self-directed learners throughout their professional life, in turn, will impact directly on the quality of nursing and midwifery practice.

Adult learning: What nurse educators need to know about mature students

Background

Most nurse educators regard students who enter postgraduate studies as adult learners capable of self-direction and independent learner behaviour. Therefore, a mismatch between the nurse educator’s expectation of adult learners and actual adult learner conduct may result in disappointment and even frustration for both educator and learner.

Purpose

This article is a report of a secondary analysis of data that were collected to explore the high-fidelity simulation learning experiences of a group of postgraduate nursing students. The secondary analysis was done to determine whether adult learners who bring professional knowledge and experience to a postgraduate learning environment displayed adult learner conduct as proposed by educational theorist Malcolm Knowles.

Method

Using a qualitative descriptive research design, data were gathered from 18 postgraduate nursing students who participated in high-fidelity simulation in a nursing school at a higher education institution in South Africa. The nominal group technique was used to collect the students’ ideas about improving their simulation learning experiences. A secondary qualitative analysis of the primary nominal group data was done.

Findings

Data either confirmed or belied adult learner behaviour. Although the findings suggested self-directed and independent learner behaviour, they also revealed behaviour evident of dependence on the educator.

Conclusion

Mature students have well established ways of thinking and doing that may hinder learning. Educators have to support adult learners in developing effective learning techniques in order to maximise the benefits of their experience and knowledge by fostering independence and self-direction.

A framework to expand public services to children with biomedical healthcare needs related to HIV in the Free State, South Africa

The study undertook the development of a framework for expanding the public services available to children with biomedical healthcare needs related to HIV in South Africa. The study consisted of various component projects which were depicted as phases. The first phase was a descriptive quantitative analysis of healthcare services for children exposed to or infected by HIV, as rendered by the public health sector in the Free State Province. The second stage was informed by health policy research: a nominal group technique with stakeholders was used to identify strategies for expanding the healthcare services available to these children. The third phase consisted of workshops with stakeholders in order to devise and validate a framework for the expansion. The theory of change logic model served as the theoretical underpinning of the draft framework. Triangulated data from the literature and the preceding two phases of the study provided the empirical foundation. The problem identified was that of fragmented care delivered to children exposed to or infected with HIV, due to the 'over-verticalization' of programmes. A workshop was held during which the desired results, the possible factors that could influence the results, as well as the suggested strategies to expand and integrate the public services available to HIV-affected children were confirmed. Thus the framework was finalised during the validation workshop by the researchers in collaboration with the stakeholders.

Responsibilities of nursing schools with regard to peer mentoring

This article reports on the postgraduate critical care students' mentoring of the third-year undergraduate nursing students during integrated work-based learning in the critical care units. The purpose of the research was to describe what the nursing school could do to improve this mentoring programme. A qualitative descriptive design was used. The nominal group technique was used to gather data from the mentors and mentees. Data from the groups were combined and qualitatively analysed into themes. Thereafter the themes were quantitatively ranked. The themes, ranking from the highest to the lowest, were orientation, organisation, mentoring process, characteristics of the mentor, and feedback to the mentor. Findings suggest that the nursing school does not always optimally support the mentoring programme. It is recommended that more than one communication medium be used to disperse information among role-players. Nursing schools should develop mentors, monitor their interactions with mentees and give them feedback on their mentoring skills. It is also the responsibility of the nursing school to select mentors that match the desired profile of mentors.

Cyclic efforts to improve completion rates of masters' degree students in nursing

Supervisors at Higher Education Institutions are challenged to shorten throughput of Master's degree students in nursing as researchers are needed to improve the art and science of the nursing profession. Globally the completion time for a postgraduate degree in the health sciences varies between 4.7 and 5.5 years. The purpose of the study was to describe strategies that were implemented to shorten completion time and attrition rate of postgraduate students. A cyclic technical, scientific collaborative mode within an action research methodology was used to identify factors impeding completion time in this study. Contrary to other studies, supervision was not an inhibiting factor in this study. Physical, technical, academic and financial aspects were identified by postgraduate students through questionnaires and informal discussion groups with supervisors as well as progress reports. Strategies were implemented to address these. Following implementation of all strategies, 42% of the postgraduate students in the School of Nursing completed their Master's degree within two years. This implies a 34% improvement. Although the completion rate improved it was still unsatisfactory and new challenges were identified during the second cycle, for example, the number of inexperienced supervisors increased and they needed mentoring. Speed mentoring is a possible solution to the problem.

Transformation: are nurse leaders in critical care ready?

AIM

The aim was to determine whether nursing leaders met the criteria for transformational and/or transactional leadership.

BACKGROUND

Many changes have occurred in South Africa and are reflected in the health-care systems. As a result, it has become crucial to source leaders who are able to manage the change process effectively so as to ensure the success and survival of our health-care organizations.

METHODS

The 45-item multifactor leadership questionnaire (Rater) was completed by 41 respondents out of a population of 121. A proportional stratified simple random sampling technique was used to select the raters of seven leaders.

RESULTS

Most nursing leaders role-modelled the culture of the organisation but did not stimulate their followers intellectually and did not demonstrate innovative motivation or individual consideration. Consequently, their followers may exhibit a lack of commitment to collective goals, with detrimental effects on the health-care organisation as a whole. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGERS: Nursing leaders should be trained to become transformational leaders so as to encourage their followers to become innovative and motivated to render high quality nursing care.

Learners' knowledge and and perceptions of voluntary counselling and testing for HIV and AIDS in the Free State Province

The study investigated the perceptions of the youth regarding Voluntary Counselling and Testing (VCT) and sexual aspects related to HIV and AIDS. The study was grounded in qualitative methodology, using 4 focus group interviews for data collection triangulating the results with field notes and literature. The participants of the four focus groups proved to be well informed on the topic and had clear perceptions concerning several aspects. They were very positive regarding the advantages of VCT for the prevention and management of HTV and AIDS. The participants recognised the need for the youth to be better informed about VCT and HIV and AIDS. They were much concerned by the lack of parental involvement in sexual education as well as the permissiveness of the youth who partook in alcohol and drug abuse as well as prostitution. Participants of the study stated that this problem was exacerbated by poverty and poor socio economic conditions.

Beliefs of grade six learners' regarding adolescent pregnancy and sex

Escalating adolescent pregnancy and risky sexual behaviour is becoming more common amongst young adolescents and especially amongst black adolescents in South Africa. Statistics confirm that South African adolescents as young as fourteen are already sexually active and become pregnant. The decision to become sexually active with resulting adolescent pregnancy whether planned or not, are directly influenced by the teenager's beliefs. A person's beliefs consist of a person' own individual beliefs or attitude as well as what the individual subjective norm which the individual perceive as other people's beliefs regarding the same object of reason. The aim of the study was to describe the attitude of black grade six learners under the age of fourteen, towards adolescent pregnancy and sex. A quantitative descriptive research design was used. Results were clustered according to demographic variables as well as beliefs that consist of attitude and subjective norm. Findings provided insight into the beliefs of grade six learners regarding sex and adulthood, the roll of peer pressure, relationships of adolescent parents, social interaction of teenage parents, ability of adolescent parent's ability to provide in the needs of the baby, the adequacy of a child support grant to raise a baby as well as the levels of education of adolescent parents. This article provide a detailed reflection on these results and propose off a doll parenting intervention strategy as means of modification of attitude and subjective norms of grade six learners in order to alter sexual behaviour.

Integration of study material in the problem-based learning method

Throughout the world educators are starting to realise that integrated curricula reflect the “real world”. Students learn how to integrate theory appropriately with practice and it stimulates higher order thinking skills. Problem-based learning (PBL) was used as a learning strategy in an integrated undergraduate programme. A quantatative non-experimental design, a survey, was used to determine how problem-based learning influences integration of learning by the students. Using a purposive sampling method all the first-year nursing students (43) at the University of the Free State participating in the programme were included in the study. Data was collected by means of a student perception questionnaire (SPQ).

Adapting to and implementing a problem- and community-based approach to nursing education

The process of change, implemented by the School of Nursing at the University of the Orange Free State so that a paradigm shift in approaches to nursing education at undergraduate level could be achieved, is outlined. The necessity to change, the identification of external and internal variables that impact on change, the founding of a support system, the process of overcoming resistance to change, the evaluation of the process of change and options for the future, are discussed. The rationale for the implementation of a problem-based teaching strategy and the phasing in of a community-based approach to teaching as the heart of the process of change are discussed.