The needs of community service nurses with regard to supervision and clinical accompaniment
Shezi, Busisiwe Eunice
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A new category of community-service nursing practitioner who was the equivalent of a newly qualified nurse emerged in the years 1998–2007. Community service was introduced by the national Department of Health in an attempt to retain professional nurses. The community service nurse is registered with the South African Nursing Council in the category “community service”. Community service nurses need to obtain clinical experience under the supervision of experienced professional nurses in a public health facility for a period of one year. Globally, health-care systems have been affected by an increase in conditions such as maternal and child morbidity and mortality, an ever-increasing vulnerability to communicable diseases (tuberculosis and Acquired Immune Deficiency Syndrome) and violence in under-developed and developing countries. These challenges have resulted in the escalation of health-care costs and a shortage of human resources in the health-care system. The escalation of these conditions has put further strain on the effectiveness of an already struggling health-care system, and the delivery of health-care services to those who are most in need. This necessitated the implementation of community service. The provincial Department of Health usually identifies where the critical need for the placement of community service nurses is, and the diplomate or the graduate can select one of three placements. However, the final decision for placement remains that of the provincial Department of Health. This community service strategy, which aims to empower community service nurses, is a contentious matter, as these community service nurses are often placed in an area where they have to work independently within the first year after qualifying as a diplomate or graduate without being supervised and supported in the public health facility. The community service nurses experience a lack of confidence and competence due to limited clinical exposure resulting from full and compacted nursing education programmes. The need for an experienced professional nurse as supervisor with a clearly defined job description by the provincial Department of Health is mandatory to prevent role conflict and confusion. However, the provision of such supervision has not yet materialised because of the shortage of experienced registered nurses in the health-care system. Research design: A qualitative design using exploratory, descriptive and contextual strategies ensured access to tangible information regarding the supervision and clinical accompaniment needs of community service nurses. Data collection: Data was collected using semi-structured interviews, field notes and digital voice recordings. The participants were community service nurses who had completed six months of their community service year. A total of n = 12 participants out of N = 38 were interviewed in the three hospitals of the Amajuba District in KwaZulu-Natal until no new data emerged and data saturation was reached. Data analysis: Content analysis assisted the researcher in scrutinising the data by coding, categorising into themes and sub-themes to clarify the data. Literature control was used to underpin the research findings. Research findings: The community service nurses appeared to be in desperate need of clinical supervisors to guide, coach, support, and be a role model to them. Community service nurses needed to develop confidence, competence, independence and critical thinking skills during community service practice. In reality, not all community service nurses were fully competent and independent to practise autonomously during their community service, though some had acquired all the above mentioned skills. However, it stood to reason that competence developed in the period of community service and was influenced by clinical supervision from experienced registered nurses, who assisted with continued development of skills in clinical practice.
- Health Sciences