Theses and dissertations (Health Sciences)
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Item System, cognitive and emotional support of students during clinical placement : exploring the experiences of students from a college of nursing in KwaZulu-Natal, South Africa(2022-05-13) Makhetha, Thembeka Dorothy; Ngxongo, Thembelihle Sylvia PatienceIntroduction and background: Nursing education was introduced to improve the quality of nursing, and includes theory and clinical components of the curriculum which should be integrated to ensure that the course content that is taught covers the needs of the community, and that the graduate nurse is competent enough to care for the health care users. Clinical training is an essential component in the provision of nursing education and training that ensures the production of competent nurse cadres with the necessary competencies to respond to current and ever-changing healthcare needs of a diverse population. The South African Nursing Council (SANC) mandates that students should be supported throughout their training programme during clinical placement. Nevertheless, research highlights that support is one of the many challenges that are faced by students in the clinical learning environment. AIM OF THE STUDY The aim of the study was to explore and describe the experiences of students from a college of nursing in KwaZulu-Natal (KZN) regarding system, cognitive and emotional support received by the students during clinical training. OBJECTIVES OF THE STUDY The objectives of the study were to 1) Describe the experiences of students from a college of nursing in KZN with regards to system, cognitive and emotional support during clinical placement, 2) Determine if system, cognitive and emotional support was given to students during clinical training, and 3) Identify strategies that could be implemented to facilitate system, cognitive and emotional support to students during clinical placement. Method: A quantitative, non-experimental descriptive study design was undertaken using Schlossberg’s Transition Theory as a theoretical framework to guide the study. Ethics approval to conduct the study was received from the institutional Ethics Committee (IREC 151/20). Data was collected using a selfadministered questionnaire between February and March 2021 from 214 3rd and 4 thyear nursing students who were registered for a four-year basic nursing programme in KZNCN, and analysed using version 21 of SPSS. Findings: The findings of the study confirmed that although all forms of support (system, cognitive and emotional) were given to students, several gaps prevailed, for example, negotiating student workloads with clinical staff. A significant difference was noted in the response regarding cognitive support between the 3rd and the 4 th year students. Conclusion The findings from the current study confirmed that in a college of nursing in KZN, South Africa, system, cognitive and emotional support of students during clinical placement was evident but there were several gaps that still needed to be addressed. These findings confirmed the anecdotal evidence by the researcher which, together with research evidence, raised concerns regarding availability of system, cognitive and emotional support to nursing students during clinical placement. Recommendations: Recommendations to address gaps identified are made with regards to policy formulation, review and implementation, service delivery, nursing education. Further research is recommended regarding adherence to policies and guideline by nursing education and health care institutions involved in student clinical training in the matter of student support. Some recommendations are directed to the students who should acknowledge that to groom them into responsible professional support offered to them is informed by several factors including the level of training as support needs differ from level to level. Students should also acknowledge that at selected levels of training support made available to them students is adjusted to allow them to grow into independent practitioners as they exit the training programme to assume the duties and responsibilities of being professional nurses.Item Transcultural self-efficacy among student nurses in a private nursing school(2022-05-13) Somoloo, Premalena; Razak, Ayisha; Pillay, PadminiIntroduction Transcultural nursing is a formal area of study and practice focused on comparative holistic culture, care, health, and illness patterns of people with respect to differences and similarities in their cultural values, beliefs, and ways of life with the goal of providing culture-congruent, competent, and compassionate care (Leininger 1991:29). Nurses are in a unique position to embrace transcultural nursing as it impacts on health care practices and their ability to communicate effectively with patients. An increase in cultural competency usually leads to culturally congruent customary care to accommodate patients’ beliefs, cultural values, lifestyles, practices, and traditions (Schmidt 2015:3). Aim of the study The aim of the study was to explore the level of transcultural self-efficacy among student nurses at a private nursing school in Durban, Kwa Zulu-Natal. Methodology A qualitative research design with an ethnographic, descriptive narrative was used in this study. Ethnography is a qualitative paradigm which involves the description of cultural behaviour, cultural patterns and experiences and shared meanings that shape behaviour (Polit and Beck 2018:220). Data collection comprised of four stages, participant observations, focus group interviews, diaries, and reflections. Focus group interviews were analyzed using Leininger and McFarland’s (2002: 97) four phase data analysis. Findings The research questions were answered regarding the competence, skills, self-efficacy, and confidence of student nurses in their experience of nursing patients from diverse cultures. Three major themes, sub-themes and categories emerged, and these were awareness and self-awareness of culture, respect, caring and self-efficacy. The results showed that nurses believed that the more knowledge and experience they were exposed to, the more skilled and competent they would become, and this would enable them to be confident and efficient in delivering transcultural nursing care.Item Clinical learning environment and supervision of student nurses' in a private nursing college : a cross sectional study(2021-05-27) Mbonambi, Maureen Phindile; Orton, Penelope Margaret; Radana, Nolundi (Jevu)ABSTRACT BACKGROUND: it is in my view that nursing education relates to the process of teaching and learning, given by nurse educators and clinical facilitators to nursing students. The teaching and learning process is conducted in a special Clinical Environment (CLE) entailing theoretical and practical learning. In addition to the teaching personnel, the clinical facilitators are responsible for placement of students in positive learning facilities for practical orientation in the clinical learning outcomes. It is these interactive processes that determine the state of readiness of the students in regards to their suitable attitudes required to provide nursing care. AIM OF THE STUDY: The purpose of this study is to describe nursing students’ experiences of clinical learning and clinical supervision at a private nursing college in eThekwini, in order to achieve improvements. METHODOLOGY: This study is influenced and guided by the quantitative, descriptive cross-sectional survey. It was done among student nurses (n = 120) at a private nursing college in eThekwini which offers the bridging course leading to registration as a Registered Nurse (R683) (South African Nursing Council 2006). In this study, data was gathered using the Clinical Learning Environment and Supervision (CLES) questionnaire developed by Mikko Saarikoski (2002), and it was analyzed by means of IBM SPSS statistics version 21. RESULTS: According to the study a general consensus has provided meaningful situations in the clinical learning environment. The clinical managers should give feedback to student nurses as it enhances their learning process. DISCUSSIONS: Findings in this study revealed that most participants were motivated and optimistic, and according to them, there was a positive clinical atmosphere; which is the most important features of a good clinical environment. RECOMMENDATIONS: It is encouraged that the clinical facilitators make more visits to the wards where the students are allocated for greater learning ability by the students. Professional nurses in the wards are to create a positive learning environment and use the presence of the students to maintain trust and prevent confusion.Item A description of pedagogical practices and student nurses’ critical thinking in a private nursing education institution in Pietermaritzburg, KwaZulu-Natal : a case study(2020-11-30) Bridgelall, Nisha; Orton, Penelope Margaret; Coopasami, M.Health care in South Africa has steadily evolved into a dynamic and complex environment coupled with the added burden of severely constrained resources. At the same time nurse practitioners are challenged daily, to provide safe, comprehensive and quality patient care. Clinical practice in nursing requires nurse graduates who are adequately trained in critical thinking skills (CTS). However, empirical evidence has highlighted that there is a lack of nurse graduates with this competency in the work environment. Consequently, the demand to produce self-directed, autonomous nurse professionals who are critical thinkers, has become a vital criterion in student nurse training. Therefore, it is incumbent that nurse educators integrate the development of CTS into their teaching strategies. Since critical thinking is an on-going process in using theory to guide clinical practice, it is imperative that nurses’ critical thinking abilities in clinical practice be measured. This will ensure the graduation of qualified nurse professionals who will deliver safe, qualitative, optimal and comprehensive nursing care with positive outcomes. Previous studies concur that it is the nurse educator who is responsible for inculcating this fundamental concept in student nurses however, finding methods for teaching the process of critical thinking has been a challenge for nurse educators that has spanned many decades. Now more than ever before there is a need for nurses who possess high-level CTS as a key competency, who can make effective clinical decisions, solve complex clinical problems, and provide quality patient care. This study focused on measuring student nurses’ critical thinking abilities in clinical practice and describes current instructional practices of nurse educators at the selected nursing educational institution (NEI). Alfaro-LeFevre’s (2016) theoretical model offers a definition of critical thinking (CT) as applied in the context of clinical practice. It describes the construct of CT as the integration of four components. For each of the components, Alfaro-LeFevre proposes a series of indicators of CT, called critical thinking indicators (CTIs). The CTIs are descriptions of behaviors that demonstrate the knowledge, attitudes, and skills that stimulate critical thinking in clinical practice (AlfaroLeFevre 2016). Aim The aim of this study was to measure the CTS of student nurses in the clinical setting and to describe the pedagogical practices of nurse educators at a selected NEI in Pietermaritzburg, KwaZulu-Natal. The findings of this study will contribute to CT development of nurses which is a fundamental skill for success within the rapidly changing healthcare arena of contemporary society. Methodology A descriptive, qualitative case study design using a multi-method approach to collecting data within a post positivist paradigm was adopted. The population comprised nurse educators and nursing students in a nursing college. The Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice) developed by Zuriguel‐Pérez et al. (2017) was chosen as the most appropriate instrument to assess student nurses’ critical thinking in practice. A sample of 120 student nurses completed this selfadministered quantitative data tool. Concurrently, qualitative focus group discussions were held to explore the pedagogic practices of nurse educators at the selected NEI. Results Qualitative and quantitative evidence in this study revealed that CTS were not being developed, initiated or supported both in the classroom and in the clinical environment. The relationship between socio-demographic factors such as age, language barriers, selection criteria, low motivation and negative attitudinal dispositions in students appeared to be major obstacles and inhibiting factors in critical thinking development. There was a lack of the use of creative and innovative pedagogic methods by nurse educators and the predominant practice was the lecture-method. The clinical setting presented further obstacles such as staff shortages, lack of clinical support, poor role modelling, lack of learning opportunities and lack of equipment and supplies. Conclusions The healthcare environment is dynamic and complex in and of itself, but the complexity is magnified by numerous further obstacles that exist as enumerated above. Critical thinking skills development is being severely compromised due to these issues. This has further widened the theory-to-practice gap which is a major concern in providing safe and beneficial patient outcomes. Now more than ever before, there is an urgent need for nurses who possess high-level CTS for effective clinical decision-making, problem-solving and the provision of quality patient care. Concerted efforts must be made to transform the classroom environment with creative and innovative teaching methodologies. Nurse educators lack adequate resources and must be equipped on how to teach for critical thinking development. Pedagogic practices must accommodate the millennial cohort who make up the majority of the nursing students. English comprehension as a compulsory subject in the beginning of the nurse training must be added to nursing curriculums. The effectiveness of teaching strategies must be measured for critical thinking development to demonstrate change over time. A clarion call is made for all stakeholders, the nursing faculty, nurse leaders in the clinical environment, professional bodies and legislature to come together and redesign the nursing curriculum to address the diversity of issues that infiltrate and impact the nursing profession. Recommendations It is recommended that further research be conducted on CTS measurement in multiple private and public NEIs and that the clinical settings be varied so as to ascertain a more comprehensive outcome. Given that personal characteristics function as an activating element in thinking ability, it is recommended that further studies be conducted to explore the demographic determinants of students such as selection criteria, age, language, diverse learning needs and backgrounds. Further research is recommended to explore the correlation between the clinical experience of nurses and the acquisition of CTS in the South African context. The addition of English language modules for students challenged in this regard should be considered. Alternative approaches in educational design in order to maximize learning for millennial students is recommended. Further studies to ascertain whether nurse educators are adequately equipped to teach for CTS development will add to the body of knowledge. This is the first study of this nature with this specific instrument to measure CTS that has been conducted in South Africa and the findings may therefore serve as baseline data for further research in this area.Item A comparative descriptive survey of the professional values of final year student nurses in a college and a university in KwaZulu-Natal(2019) Malambe, Mumcy Zandile; Orton, Penelope Margaret; Razak, A.Introduction: There have been a lot of complaints from the public about professional nurses’ conduct and lack of caring in South African health care facilities. Nurses don’t seem to care about patients and the public cannot trust the nurses due to the way nurses treat patients in the health care facilities. Student nurses are socialised with nursing professional values during their training either from a university or from a nursing college and are expected to have mastered these professional values by the final year of their studies before they go and practice as professional nurses. Aim of the study: The aim of the study was to describe and compare the professional values of final year student nurses in a college and a university in KwaZulu-Natal. Methodology: A quantitative survey design was used to describe and compare the professional values of final year student nurses doing the comprehensive four-year course. A validated Nurses Professional Value Scale (NPVS) 26 item revised questionnaire was used to collect data from 128 college and 83 university students after receiving ethical clearance. Non-probability sampling using a Random and consecutive sampling was used to select the college campuses and the students were selected using purposive sampling method. Analysis was undertaken using SPSS version 23. Results: The descriptive statistics reported on the five factors of the NPVS, which were patient privacy, ethical practice, activism, research and leadership. The majority of the sample viewed patient privacy and ethical practice as the most important values and leadership and research was rated low. There was a statistically significant difference in professional values between the college and the university respondents, with the university respondents scoring higher than the college respondents which indicated that university respondents had more professional values than college respondents. Recommendations: This included teaching and assessment of professional values, ethical practice in clinical placement, leadership training for student nurses and self- directed learning to update their knowledge and research.