A model of collaboration in implementing Problem Based Learning (PBL) in Nursing Education

Abstract

To meet health care challenges brought about by the patterns of diseases such as HIV, Tuberculosis, Sexually Transmitted Diseases (STDs), chronic conditions and malnutrition, nurse educators are required to redirect their teaching strategies to those that promote critical thinking in order to develop nurses who are critical, reflective and analytical. It is therefore important to continually adapt teaching strategies to meet the changing health-care needs of the country. The purpose of this study was to develop a collaborative model of implementing PBL in the nursing education context. The study was conducted in two phases, namely, exploration and description of the opinions of the nurse educators, nurse managers and preceptors regarding collaboration in PBL in nursing education and model development. In phase 1, an exploratory sequential mixed methods design (Creswell & Clark, 2007) was used to explore the opinions and views of participants regarding collaboration in implementing PBL in nursing education. For the qualitative component, a sample of 44 respondents was purposively recruited to participate, whereas for the quantitative component participants were conveniently recruited. The findings from the qualitative design and literature review informed the development of a survey instrument from a larger population (n=96) of nurse educators from the South African Higher Education Institutions offering PBL nursing education, nurse managers and preceptors from clinical services in the North-West Province where PBL students are placed for clinical learning.

Both qualitative and quantitative data indicated the need for various types (interprofessional, inter-disciplinary, and inter-institutional) of collaboration; benefits of collaboration to staff, students, organizations and health care users; factors and barriers to successful collaboration in implementing PBL. The data from this process formed the basis for concept analysis and model development. Phase 2 included a model development and consisted of concept analysis and model development. The concept of interest in this study is collaboration, which was identified from the interviews analysed according to the Rodgers and Knalf's (2000:80) Evolutionary Method. The results of concept analysis were integrated in the process of concept development. The concept collaboration was classified within a practice model as prescribed by Dickoff, James and Wiedenbach (1968:434-435) using the elements of practice theory. The collaborative model was developed according to Chinn and Kramer (20 11: 195). The developed model for collaboration in the implementation of PBL has six main elements, namely: the Higher Education; Nursing Education and Health Care Services (Context); institutions initiating PBL, clinical services, colleges affiliated to Universities, students and health care users (recipients); Centre's of Excellence in PBL (Agents); effective implementation of PBL (terminus); collaboration (process); and commitment, communication, cooperation, trust and respect (dynamics). Guidelines to ope rationalize the model, which include the strategic management and leadership, should be committed to the collaboration by offering support, commitment of time, energy and resources. Leadership and commitment are basic to success of collaboration. Accordingly, the South African Nursing Council (SANG) should obligate professional nurses to be involved and collaborate in education of nursing students, especially in clinical services. Good interpersonal relationships and communication skills should be maintained between academic institutions and clinical health services to promote participation in the collaboration. Health-care authorities should provide authentic learning opportunities for PBL nursing students through policies, procedure and protocols. Nurses in the health-care services must be trained on PBL and collaboration skills; clinical staff must participate in PBL curriculum planning, implementation and evaluation together with roles, responsibilities and tasks of clinical individuals, teams. And institutions should clearly detail, in the Memorandum of Understanding (MOU), issues of collaboration to ensure shared accountability and ownership. Recommendations for research include, inter alia: piloting the model and evaluating it; further research on collaboration in implementing PBL at different levels of operations; cultural influences on collaboration; criteria to assess effectiveness of collaboration; and development of an evaluation instrument of the model.