Scielo RSS <![CDATA[African Journal of Health Professions Education]]> http://www.scielo.org.za/rss.php?pid=2078-512720200004&lang=en vol. 12 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Collaboration</b><b>: </b><b>A potential solution to imminent issues facing nursing and midwifery education in Africa?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Exploring internal quality assurance for nursing education in the State University of Zanzibar, Tanzania: A preliminary needs analysis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400002&lng=en&nrm=iso&tlng=en BACKGROUND. A quality assurance (QA) process is acknowledged as important to ensure good higher education outcomes and graduate competence. Complaints about the quality of recent nursing graduates in the Department of General Nursing and Midwifery at the State University of Zanzibar (SUZA), Tanzania, suggested that current QA concepts and processes may be inadequate and should be investigated prior to making recommendations for improvements. OBJECTIVES. To explore the awareness of QA in higher education among nurse educators and students at SUZA, and the extent to which the Department of General Nursing and Midwifery currently monitors and evaluates teaching and learning. METHODS. Six nursing educators and 20 third-year nursing students were interviewed regarding their understanding of the concept of internal quality assurance (IQA) and procedures and their awareness of the internal processes that are currently in place in the department. RESULTS. All the nurse educators had heard of IQA, but only 2 (33%) had detailed knowledge of the processes involved. None of the students knew what IQA entails. Most of the educators identified the monitoring of test scores and pass rates as part of an evaluation process. They were also aware of course evaluations by students, but believed these to be untrustworthy. The students did not understand that course evaluations were part of IQA and did not recognise the potential value of these evaluations. There was an understanding by 35% of students of continuous assessment to monitor individual progress, and 20% identified occasional meetings with the head of department to provide feedback on the course. CONCLUSIONS. A comprehensive programme of education around QA is suggested for educators and students of nursing at SUZA as a first step in the introduction of a well-planned and supported IQA process. <![CDATA[<b>Facilitators and challenges experienced by first-year nursing students at the University of Fort Hare, South Africa, when conducting home visits</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400003&lng=en&nrm=iso&tlng=en BACKGROUND. To be socially responsible, tertiary education institutions collaborate with local communities. Community engagement is a teaching and learning strategy that enhances the learning experiences of students while interacting with community members. Assessing a family at home is a curriculum task that strengthens a primary healthcare approach to nursing education. OBJECTIVES. To explore and describe facilitators and challenges experienced by first-year nursing students regarding family assessment during home visits. METHODS. An explorative, descriptive, qualitative research approach was used. Four focus group discussions with 6 participants in each group were conducted with purposively selected first-year nursing students. Data were analysed according to Tesch's method. RESULTS. Participants (N=24) were allocated to the focus group discussions. Facilitators of learning included relevant community and home settings, which provided diversity in learning opportunities. Challenges included absence of a formal orientation to the learning opportunity, language barriers and lack of basic apparatus. CONCLUSION. Participants reported facilitators and challenges of family health assessment and health education. The first step should be to build on the facilitators and address the challenges in an action research project. <![CDATA[<b>Supportive framework for teaching practice of student nurse educators: An open distance electronic learning (ODEL) context</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400004&lng=en&nrm=iso&tlng=en BACKGROUND. Teaching practice is an integral part of the preparation of student nurse educators. It provides students with an opportunity to translate theory into practice and to gain knowledge and skills to become effective and competent nurse educators. OBJECTIVES. The study sought to explore experiences of student nurse educators who attended a teaching practice workshop (students attend one session for 5 days at the third-year level of training) and to develop a supportive framework to enhance the acquisition of pedagogical skills. METHODS. A qualitative, phenomenological research design was used. Out of 35 participants who attended the workshop, 20 consented to participate in the study. Data were collected through written narratives and analysed using thematic content analysis. A purposive sampling technique was followed. RESULTS. Most participants reported a number of challenges experienced during teaching practice, which were grouped into six themes, namely: poor orientation, lack of adequate support by supervisors, teaching strategies not aligned with open distance electronic learning, expectation of doing a PowerPoint presentation without prior knowledge, use of an outdated study guide, and limited time for teaching practice. CONCLUSION. Orientation of students for teaching practice needs to be detailed, accessible online after sessions, and conducted via video classes, podcast, smartboards, etc. before a workshop. Support and guidance should be provided through prompt feedback on lesson planning and online classes to teach principles and procedures of lesson presentation. Promotion of computer skills and allocation of more time for teaching practice are necessities. <![CDATA[<b>A competence assessment tool that links thinking operations with knowledge types</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400005&lng=en&nrm=iso&tlng=en BACKGROUND. Although there is a need for a greater number of nurses to meet the demands for universal health coverage, these trained nurses should also be competent. However, assessment of nurses' competence remains a challenge, as the available instruments do not focus on identifying the knowledge level that is lacking. OBJECTIVES. To report on the development and reliability of an instrument that can be used to assess undergraduate student nurses' competence. METHODS. A methodological research design was used. The authors extracted items from existing competence assessment instruments, inductively analysed the items and categorised them into themes. The extracted items were used to draft a new instrument. Review by an expert panel strengthened the content and face validity of the instrument. Twenty assessors used the developed assessment instrument to assess 15 student nurses' competence via video footage. RESULTS. The Cronbach alpha coefficient of 0.90 and intraclass correlation coefficient of 0.85 indicate that the instrument is reliable and comparable with other instruments that assess competence. Conclusions. Nurse educators can use the developed instrument to assess the competence of a student and identify the type of knowledge that is lacking. The student, in collaboration with the educator, can then plan specific remedial action. <![CDATA[<b>Mentors' and student nurses' experiences of the clinical competence assessment tool</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400006&lng=en&nrm=iso&tlng=en BACKGROUND. The assessment tool for registered comprehensive nursing was introduced in nursing education in Uganda in 2005 with the main purpose of facilitating nurse mentors to easily assess the clinical competency of student nurses. The tool contributes to the formative and summative assessment of students. Despite continued use of the assessment tool over the years, no study has been conducted to explore the perceptions of nurse mentors and students regarding its use. OBJECTIVE. To explore the experiences of nursing students and their mentors regarding the clinical competence assessment tool. METHODS. A qualitative exploratory study design was used. The study was conducted at Masaka School of Comprehensive Nursing in Uganda. The participants included 48 final-year nursing students and 5 nurse/midwifery mentors. Purposive sampling was used to select the participants. Data were collected using 6 focus group discussions with students and 5 key informant interviews with mentors, and thematic analysis was used to interpret the data. RESULTS. From the responses, the participants generally had mixed experiences of the tool and suggestions were put forward for improvement. Five major themes emerged from student responses: (i) the orientation process; (ii) using the assessment tool; (iii) strengths of the assessment tool; (iv) challenges with the assessment tool; and (v) suggestions for improvement. The nurse mentors generally corroborated what the students reported, i.e. that the tool had challenges when one assesses student performance and gives feedback. CONCLUSION. The participants reported satisfaction with the design of the assessment tool. However, some challenges were identified regarding its implementation by students and mentors. Key among these were the failure to have immediate assessment and feedback to students. Findings from the study could offer insights on how the tool could be improved. <![CDATA[<b>Practice guidelines for peer support among educators during a curriculum innovation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400007&lng=en&nrm=iso&tlng=en BACKGROUND. Curriculum transformation in nursing education addresses changing healthcare needs of communities. However, without ongoing support of educators, the fidelity of curriculum enactment could be compromised. Nursing education institutions in Lesotho implemented a competency-based curriculum that required novel pedagogical approaches. New facilitation approaches can challenge implementers, as was observed during the implementation of a new curriculum for the midwifery programme in Lesotho. Without ongoing faculty development and support, the educators resorted to supporting one another. However, the sustainability and effectiveness of the unstructured peer support could be compromised; hence the need to develop guidelines to enhance peer support among educators during curriculum innovation. OBJECTIVE. To develop and validate guidelines to enhance peer support among educators during curriculum innovation. METHODS. A qualitative research design with multiple data collection methods was conducted, guided by the World Health Organization Handbook for Guideline Development as the framework. Three interrelated phases, inclusive of an integrative review, an exploratory qualitative study, guideline development and validation, were conducted. External reviewers validated the developed guidelines by means of a Delphi survey. RESULTS. Five priority areas were identified for the practice guidelines, i.e. attributes of peer supporters, peer support strategies, content/support needs, outcomes of peer support, and monitoring and evaluation of the peer support strategy. Recommendations were formulated for each priority area. CONCLUSION. These practice guidelines provide relevant recommendations that can enhance peer support among educators in nursing education programmes during curriculum innovation. The recommendations serve as a blueprint and provide direction for the structured peer support engagements. <![CDATA[<b>Converging professional nurses' perceptions and community service nurses' experiences regarding clinical competence during community service placement</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400008&lng=en&nrm=iso&tlng=en BACKGROUND. Transitioning from a student to the role of a newly qualified nurse can be difficult when not well prepared. The expectation is that newly qualified nurses should reflect competency across a wide range of skills. To acquire and improve the necessary skills, many countries opted to introduce and implement strategies to prepare nurses for their professional roles. In South Africa (SA), the newly qualified nurse is required to perform an obligatory 12 months' community service as mandated by the regulation promulgated by the Minister of Health. OBJECTIVE. To report the convergence results of the perceptions of professional nurses and the experiences of community service nurses (CSNs) regarding clinical competence of the latter during placement in North West Province (NWP), SA. METHOD. The study followed a qualitative, explorative, descriptive and contextual design. It employed the World Café data-collection method, including 21 purposively sampled participants. Benner's levels of competence scale was used to rate the competence of CSNs. Pienaar's four steps of qualitative thematic analysis were adapted to analyse data. RESULTS. Three main themes emerged, i.e. ethos and professional practice; unit management, governance and leadership; and contextual clinical and technical competence. CONCLUSION. The World Café method allowed for real conversations around mutual topics of interest, and rich data collected is a true reflection of the participants' perceptions and experiences. These results contributed to the development of a clinical competence evaluation tool for CSNs in NWP. <![CDATA[<b>The emergence of a clinical skills laboratory and its impact on clinical learning: Undergraduate nursing students' perspective in Limpopo Province, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400009&lng=en&nrm=iso&tlng=en BACKGROUND. Skills laboratory training is used as a teaching strategy to assist nursing students in developing clinical skills. This educational intervention assists nursing students to develop expertise in clinical skills to ensure the safe care of patients. Since the establishment of a new skills laboratory, the Department of Nursing Science, University of Limpopo, South Africa has not evaluated the impact of the laboratory on the clinical learning of nursing students. OBJECTIVE. To explore and describe the impact of clinical skills laboratory sessions on undergraduate students in the department. METHODS. Qualitative, descriptive research explored the impact of skills laboratory sessions on undergraduate students. Purposive sampling was used to select participants for the study. Unstructured one-on-one interview sessions were conducted and 12 students were interviewed until data saturation was reached. Thematic content was used for data analysis. RESULTS. Three themes emerged: the impact of skills laboratory sessions on undergraduate nursing students; the existing benefits of skills laboratory learning sessions; and the importance v. insignificance of laboratory skills lecturers in clinical teaching. CONCLUSION. The study revealed that the clinical skills laboratory has a positive, diverse impact on the clinical learning of nursing students. The sessions should be integrated into the curriculum, as they aid in translating theory into practice. Nursing institutions must have a clinical skills laboratory, as they prepare student nurses for learning in a clinical area. <![CDATA[<b>Evaluating the outcomes of a faculty capacity development programme on nurse educators in sub-Saharan Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400010&lng=en&nrm=iso&tlng=en BACKGROUND. The efficient education, deployment and ongoing retention of the nursing and midwifery workforce are key strategies to ensure a well-functioning healthcare system. The African region, however, has relatively few funded programmes to develop educational research capacity in novice academics while also addressing their leadership and educational needs. OBJECTIVES. To evaluate the outcomes of a faculty capacity development programme on nursing and midwifery educators in sub-Saharan Africa (SSA). This study explored the scope of scholarship outcomes, career trajectories and leadership outcomes. METHODS. A mixed methods study collected quantitative and qualitative data from nursing and midwifery educators (N=26) who enrolled for the sub-Saharan Africa-FAIMER Regional Institute (SAFRI) fellowship between 2009 and 2019. Data from project abstracts presented at a local conference and a subsequent electronic survey were included for review and analysis. Deductive thematic analysis was used to report the findings. RESULTS. Most projects (n=24) focused on undergraduate programmes at the home institutions. All the projects were presented at a local conference and 4 projects were published in peer-reviewed journals. The projects impacted on community and curriculum change, led to improvements in teaching and research and various strategies to improve learning and assessment at home institutions. The reported outcomes relating to the career trajectories of 7 fellows indicate that the programme accrued benefits to their institutions and the community, to students and their peers, and that they experienced personal benefits. CONCLUSION. The SAFRI fellowship vision is evident in the projects and subsequent actions of its nursing and midwifery fellows. Nurse educators' engagement with pedagogical evidence and design strategies has culminated in knowledge to solve some of the education-related challenges in their nursing education institutions. <![CDATA[<b>Stakeholders' community-engaged teaching and learning experiences at three universities in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400011&lng=en&nrm=iso&tlng=en BACKGROUND. Transformation forces in South African (SA) higher education and beyond have called for incorporation of community engagement into higher education. Specifically, the SA white paper 3 that informed the Higher Education Act No. 101 of 1997 mandated higher education institutions, including those involved in the training of nurses, to move towards community-engaged teaching and learning (CETL). An array of interventions has been implemented that aim at magnifying community-engaged pedagogical practices in SA universities, including nursing departments. However, this has not been without challenges. OBJECTIVE. To describe stakeholders' CETL experiences at three SA universities. METHODS. A phenomenological descriptive qualitative study using focus group discussions and semi-structured interviews was conducted with academics, students and community members at the health sciences departments of three universities that applied CETL approaches. Data were analysed through an inductive thematic approach and the outcomes are presented as themes. RESULTS. Four themes emerged from the data: empowerment; forms of CETL; principles of CETL; and awareness. CONCLUSION. Stakeholders in CETL at the health sciences and nursing departments at three universities in SA indicated a rich array of experiences that can be used to leverage a transformative effect in nursing education. Appropriate integration of CETL into programme design and development of curricula, and use of explicit CETL methods with intentional outcomes for the students and communities, will go a long way toward achieving transformation in nursing education. <![CDATA[<b>The use of an online learning management system by postgraduate nursing students at a selected higher educational institution in KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400012&lng=en&nrm=iso&tlng=en BACKGROUND. The use of information and communications technology (ICT) in nursing education is a key strategy following the impact of COVID-19 on higher education institutions. It highlights the need for efficient learning management systems and meta-capabilities of graduates. Studies have described e-learning at the undergraduate level, while less is known about learning management systems (LMS) use among postgraduate nurses. OBJECTIVES. To explore students' perceptions of e-learning, their perceived challenges with technology on a compulsory postgraduate nursing module and associations between demographic data and listed challenges. METHODS. An exploratory quantitative study used a self-administered questionnaire to collect data from all postgraduate students (N=60). Data included demographics, language proficiency, prior training, computer access at home, frequency of use, prior exposure to e-learning platforms, attitude to technology, perceived computer self-efficacy, and anxiety and attitude towards computer use for learning. Statistical analysis included using frequency distributions, χ² and Pearson's test to measure and explore associations between challenges and sociodemographic factors. RESULTS. The cohort consisted of mainly black (95%) and female (75%) students. They expressed positive views about technology usage. Seventy percent reported first-time exposure to the Moodle learning management system at the university, and 68.3% had access to a computer. The majority (66.7%) expressed having limited ICT skills and difficulty using Moodle. Statistically significant associations were found between the ability to use Moodle and proficiency in English, computer literacy, availability of technical support and access to computers. CONCLUSION. E-learning has the potential to yield positive outcomes for continued professional learning. Students should be proficient in English, and require early introduction, training and technical support to use Moodle effectively. <![CDATA[<b>Nurse educators' views on implementation and use of high-fidelity simulation in nursing programmes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400013&lng=en&nrm=iso&tlng=en BACKGROUND. Clinical skills development of student nurses is a concern in nursing education owing to limited clinical exposure and learning opportunities. High-fidelity simulation as a teaching-learning strategy creates an environment where student nurses develop clinical skills through interactive participation. OBJECTIVES. The aim of this research study was to explore nurse educators' views of high-fidelity simulation as an educational approach in nursing programmes. METHODS. A qualitative descriptive design was used. Data were collected through individual semi-structured interviews. Data saturation occurred within 19 interviews. The population consisted out of 33 (N=33; n=19) nurse educators. Direct content analysis was done using Hsieh and Shannon's approach. The study was conducted at a South African private higher education institution. RESULTS. Five main themes were identified. The nurse educators had not been exposed to or had limited experience with high-fidelity simulation. Limited resources and/or the lack of nurse educators trained in high-fidelity simulation were identified. The nurse educators agreed that high-fidelity simulation would contribute to the enhancement of clinical skills development and theory and practice integration. CONCLUSION. High-fidelity simulation is not implemented owing to limited equipment or experience in using the equipment optimally. The nurse educators see high-fidelity simulation as a solution and valuable training method where clinical skills are developed before the student nurse is exposed to the private clinical environment. <![CDATA[<b>Male students' motivations to choose nursing as a career</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400014&lng=en&nrm=iso&tlng=en BACKGROUND. Men comprise approximately 11% of the nursing population globally, and 9.1% of the South African (SA) nursing workforce. Nursing workforce shortages require strategies for recruiting new nurses, including more males. A university in the Western Cape Province, SA, reported an increased enrolment of males to the nursing programme, and wished to understand the factors motivating this, in order to improve the recruitment of males. OBJECTIVE. To determine factors that motivated male students to choose nursing as a career, and to determine any association with demographic characteristics. METHODS. Data were collected from a stratified sample of 218 male undergraduate nursing students at a residential university in the Western Cape, using a structured questionnaire to determine their demographic profile and extrinsic and intrinsic motivating factors behind their choice of field of study. RESULTS. Most respondents were single black males aged 18 - 25 years, with no dependents, who originated from the Eastern Cape Province of SA. The majority started their nursing studies when aged 20 - 24 years, and had no prior healthcare or nursing experience. The highest scoring intrinsic motivating factors were wanting to make a difference in society and a desire to help people. The highest scoring extrinsic motivating factor was wanting a stable career, while the lowest scoring extrinsic motivating factor was flexible work hours in nursing. When considering extrinsic motivations, having dependents/children was significantly associated with potential salary and other monetary benefits as well as career mobility. CONCLUSION. Men choose nursing as a career for both altruistic motivations as well as monetary benefits. These motivations should be used to attract more men into the nursing profession. <![CDATA[<b>Promoting patient autonomy: Perspectives of occupational therapists and nurses</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400015&lng=en&nrm=iso&tlng=en BACKGROUND. There has been a turn in the last decade towards autonomy in patient care. Promoting patient autonomy is required as a collaborative endeavour between the patient, healthcare professionals and the families and caregivers of patients. Our current discourse demonstrates patient autonomy as essential. OBJECTIVE. To explore the concept of autonomy in nurses' and occupational therapists (OTs)' individual and collective practice as healthcare professionals. METHODS. The study followed a qualitative explorative approach. Fourteen nurses and 12 OTs from 6 facilities in KwaZulu-Natal Province of South Africa were recruited into the study. Following ethical approval, and dependent on the availability of participants, data were collected via focus groups, triad and individual semi-structured interviews and qualitative questionnaires. Data were analysed using inductive thematic analysis per profession initially, and then later merged to develop themes. RESULTS. Two major themes emerged that spoke to the deconstruction of autonomy and deterrents to the promotion of autonomy in clinical practice. An individualistic view of autonomy was embedded within the participants' understanding of the concept. It included the patient's right and ability to self-determine or direct treatment and various interventions, having appropriate guidance and the relevant information to make decisions, and opportunities to self-determine their course of treatment. Patient-related and organisational factors served as barriers to the promotion of autonomy. CONCLUSION. By analysing the experiences of autonomy in practice of these two professions, we may be able to establish new ways of understanding how professional practice can truly become patient-centred and transition from an individualistic understanding of autonomy towards viewing autonomy as relational. <![CDATA[<b><i>AJHPE </i>special focus issue - call for papers: Innovations in health professions education during the COVID-19 era</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-51272020000400016&lng=en&nrm=iso&tlng=en BACKGROUND. There has been a turn in the last decade towards autonomy in patient care. Promoting patient autonomy is required as a collaborative endeavour between the patient, healthcare professionals and the families and caregivers of patients. Our current discourse demonstrates patient autonomy as essential. OBJECTIVE. To explore the concept of autonomy in nurses' and occupational therapists (OTs)' individual and collective practice as healthcare professionals. METHODS. The study followed a qualitative explorative approach. Fourteen nurses and 12 OTs from 6 facilities in KwaZulu-Natal Province of South Africa were recruited into the study. Following ethical approval, and dependent on the availability of participants, data were collected via focus groups, triad and individual semi-structured interviews and qualitative questionnaires. Data were analysed using inductive thematic analysis per profession initially, and then later merged to develop themes. RESULTS. Two major themes emerged that spoke to the deconstruction of autonomy and deterrents to the promotion of autonomy in clinical practice. An individualistic view of autonomy was embedded within the participants' understanding of the concept. It included the patient's right and ability to self-determine or direct treatment and various interventions, having appropriate guidance and the relevant information to make decisions, and opportunities to self-determine their course of treatment. Patient-related and organisational factors served as barriers to the promotion of autonomy. CONCLUSION. By analysing the experiences of autonomy in practice of these two professions, we may be able to establish new ways of understanding how professional practice can truly become patient-centred and transition from an individualistic understanding of autonomy towards viewing autonomy as relational.