Tanya Heyns

A conceptual framework for educational design at modular level to promote transfer of learning

Students bridge the theory–practice gap when they apply in practice what they have learned in class. A conceptual framework was developed that can serve as foundation to design for learning transfer at modular level. The framework is based on an adopted and adapted systemic model of transfer of learning, existing learning theories, constructive alignment and the elements of effective learning opportunities. A convergent consensus-seeking process, which is typical of a qualitative approach, was used for expert review. The final conceptual framework consists of two principles: establishing a community of learning and the primacy of a learning outcome. The four steps entail the following: (1) activation of existing knowledge; (2) engaging with new information; (3) demonstrating competence; and (4) application in the real world. It is envisaged that by applying the framework educators in health care will design for transfer of learning, resulting in quality of care and optimal patient outcomes.

The support needs of high-risk antenatal patients in prolonged hospitalisation.

OBJECTIVE to identify and describe the support needs of high-risk antenatal patients hospitalised for more than five days. DESIGN a qualitative, explorative and descriptive design. In-depth interviews were conducted with pregnant women during their stay in hospital until data saturation was reached. SETTING an antenatal unit in a private hospital in Gauteng Province, South Africa. PARTICIPANTS 11 antepartum women who had been hospitalised for five days or more and were of any gestation period. FINDINGS three main themes emerged: (a) a need for social support; (b) improvement of the environment; and (c) assistance with emotional adaptation and acceptance of prolonged hospitalisation. KEY CONCLUSION prolonged hospitalisation of high-risk antenatal patients disrupts the usual adaptation to pregnancy. These patients develop specific needs during hospitalisation. Findings suggest that the length of hospitalisation influences the specific support needs of antenatal patients. IMPLICATIONS FOR PRACTICE this study identified a link between social and environmental support, emotional adaptation, acceptance of hospitalisation of high-risk antenatal patients and improvement of their health status. Through reflection on these themes, recommendations can be made and strategies implemented to meet the support needs of high-risk antenatal patients.

Moving from crisis intervention towards person-centredness

Worldwide health care systems are challenged to provide high quality and safe care to all citizens. South Africa is no exception in this regard but as a nation it does have unique challenges in making this happen. At a national level, health care is delivered through a pluralistic health care system with separate public and private sectors, but each responsible for the delivery of the total health services to a population that has both third and first world health conditions (Rowe and Moodley, 2013). Furthermore, owing to the high incidence of acute and chronic diseases and high levels of societal violence, there is an ever-increasing demand for critical care services through designated critical care units. The Department of Health (2012) indicated that South Africa’s predominant nurse-based health care system therefore requires nurses to have knowledge and skills to deliver quality patient care. However, nursing is in a crisis, not only is there a shortage of nurses, but nurse leaders, managers and the public opinion reveal poor standards of nursing care. Headlines in the media (News24 2013) too demonstrate a growing perception that the quality of nursing in South Africa is a concern. Given the number of press reports and media accounts suggesting that nursing may have lost its way in delivering quality compassionate person-centred care (Parliamentary and Health Service Ombudsman, 2011), there is a need to consider how to address this problem. At the heart of these challenges, plaguing health care services is the disengagement of nurses from their work and workplace cultures (Duffield et al., 2009). The situation has led to recommendations for fundamental shifts in health care cultures, encouraging positive practice environments and the recognition of person-centred approaches. Addressing these recommendations may lead to enhancing the well-being of nurses, have a positive impact on nurse motivation, productivity and performance and in turn support quality patient care (Department of Health 2012:21; McCormack et al., 2007). The South African Department of Health and International Council of Nurses advocate that one of the critical areas that should be given attention to address the shortage of nurses in South Africa is the empowerment of nurses. This can be accomplished by participation in decision-making and sharing responsibilities for achieving quality patient care (Department of Health, 2012; Littlejohn et al., 2012). Health care services in South Africa attempt to resolve the nursing crisis by providing training using traditional education practices. The topics covered during these sessions are mainly policy driven and utilizes a ‘top-down approach’. This approach is of concern because learning is separated from the working environment, and educational approaches used consist of mainly lectures and workshops. Although there is a major focus on monitoring and evaluating patient safety using clinical governance teams and implementing for example ‘best care always’ evidence-based practices, the educational approaches used neither promote evidence-based health care nor contribute to or address the development of person-centred care cultures. Research data of two unpublished studies reveal that lectures and workshops presented at two private hospitals were not attended despite health care services providing these sessions as on-duty time (Lategan et al., 2013; Viljoen et al., 2013). The South African Department of Health and the Report of the National Nursing Summit (2011) have emphasized the need for nurses to re focus on taking responsibility for nursing care delivery, create stronger links between theory and practice and establish more effective leadership roles. Emancipatory and transformational practice development methodologies, with their focus on the development of evidence-informed and person-centred cultures, have been used internationally for many years and have been shown to be effective in changing culture, enhancing person-centredness and improving the experiences of giving/receiving care (Manley et al., 2008; McSherry and Cox, 2008). Reflecting on the crisis in critical care nursing in South Africa and the limited effectiveness of existing (mainly training) strategies for addressing this, academics from the Department of Nursing, University of Pretoria, envisioned the facilitation of change through practice development with the intent of moving the existing workplace culture towards one that would be more person-centred. The methods embraced by practice development methodology enable the recommendations of the South African Department of Health and the Report of the National Nursing Summit to be made real as they focus on shared team values, individual and team effectiveness, the use of evidence in practice, learning in and from practice using work-based and active learning approaches and the development of leadership. A collaborative agreement has been formed between the University of Pretoria and Queen Margaret University Edinburgh

APPRECIATIVE EDUCATION TO ENHANCE QUALITY OUTPUTS THROUGH ASSESSMENT AND FEEDBACK PRACTICES

Higher education is experiencing a time of change that is rife with challenges. The times call for educators in the nursing profession to facilitate learning in a way that students are empowered to become future leaders in the profession. Appreciative inquiry is an emerging educational method that is used to bring about organisational transformation in the teaching and learning arena. It is an approach to learning where emphasis is laid on positive aspects about learning rather than negative aspects. The purpose of this article is to explain how appreciative education is implemented in nursing education institutions including the assessment and feedback practices to enhance outputs.

Requirements for reflection in the critical care environment

Background Reflection is recognised as an important method for practice development. The importance of reflection is well documented in the literature, but the requirements for reflection remain unclear. Objectives To explore and describe the requirements for reflection in the critical care environment as viewed by educators of qualified critical care nurses. Method A focus group interview was conducted to explore and describe the views of educators of qualified critical care nurses regarding requirements for reflection in the critical care environment. Results The themes that emerged from the focus group were buy-in from stakeholders – management, facilitators and critical care nurses, and the need to create an environment where reflection can occur. Conclusion Critical care nurses should be allowed time to reflect on their practice and be supported by peers as well as a facilitator in a non-intimidating way to promote emancipatory practice development.

The impact of an indigenous proverb on women’s mental health: A phenomenological approach

Background Proverbs and idioms represent cultural and societal beliefs and values inherited from the forefathers. An example is lebitla la mosadi ke bogadi. Over many decades African people have used such ancient instructions to counsel women to be resilient in their marriages thus impacting on their mental health. Objective The purpose of this article was to explore and describe that proverb and its impact on womens mental health. Method Hermeneutic phenomenology was used to explore and describe the proverb and its impact on indigenous womens mental health. The population included married, divorced, widowed and single women who were attending social clubs or networks in the cities of Tshwane and Johannesburg. Snowball and purposive sampling was used to select 57 participants. Five face-to-face interviews and eight focus groups interviews were conducted. Colaizzis data analysis method was used to analyse data. Results Oppression and stigmatisation of women and their families and harmful effects that may result in death were identified as having an impact on womens mental health. Some women shared that they were oppressed in many ways. In addition, they feared stigmatisation should they wish to divorce. They constantly lived in fear of being harmed or killed by their spouses. Conclusion There was a need for nurses to develop awareness regarding cultural issues so that women are better served in primary healthcare settings. Women who are suspected of experiencing abuse, should be screened for abuse so that they can be assisted accordingly.

Clinical accompaniment let the voice of the pre-graduate students count

Nursing is a practice-based profession and it is essential that pre-graduate students are socialised in the clinical learning environment from the beginning of their training. Consequently, clinical accompaniment is regarded as a vital component of a nursing programme to offer the necessary support to pre-graduate students. The objective of this study was to explore and describe pre-graduate students’ view regarding the clinical accompaniment they received as part of the clinical component of the four-year programme. In this study a qualitative, contextual, explorative, descriptive and interpretive research design was used to explore and describe pre-graduate students’ views of clinical accompaniment as part of the clinical component of the four-year programme. The findings of the study were based on how students viewed clinical accompaniment and they revealed: inadequate support from nurse educators, lack of resources, inadequate support from registered nurses, and disregard for student status. Evaluating the clinical accompaniment of pre-graduate students utilising a positive approach of Appreciative Inquiry (AI), gave students the opportunity to give inputs into the aspect that works well (positive) as well as the challenges (negative aspects) as perceived by pre graduate students. The inputs were utilised to draft an action plan to move towards excellence in clinical accompaniment.