Strategies to enhance teaching and learning in the Primary Health Care qualification for professional nurses in South Africa

Abstract

The need for clinically skilled and competent nurses in the primary health care nursing (PHCN) services in South Africa cannot be over emphasised. It is well known that Primary Health Care (PHC) services are the community’s first contact with health care services. Several problems have been identified with the quality of the service and the skills of PHC nurses (Rispel & Barron 2012:620; Gosangaye & Mayeye, 2013:110). The teaching and learning of PHC nurses are therefore important to ensure quality services to the community. Key challenges that were identified in nursing education in general are the critical shortage of nurses, inadequate funding, and the lack of skills and competency of nurses in general (Department of health (DoH), 2008:11). Stellenberg et al. (2018:29) stated that the contributing factors to adverse events leading to litigation of nurses are, amongst others, a lack of training and knowledge and failure to apply institutional guidelines. There remain concerns about the inadequate clinical skills exhibited by nurses qualified in clinical nursing science, assessment, diagnosis, treatment and care (CNSTC) in PHC clinics in South Africa. This research aimed to identify strategies for enhancing the teaching and learning of clinical skills in the CNSTC programme. The ultimate goal was to provide strategies that would improve the teaching and learning of clinical skills to provide clinically competent nurses who are able to render excellent and safe patient care that coincides with the planned transformation of the South African health system. A qualitative design was followed with exploratory, interpretive, descriptive and contextual strategies and took place in consecutive phases. In phase one the principles of an Appreciative Inquiry (AI) were applied in interviews to determine the approaches of clinical teaching and learning that are currently applied in higher education institutions in South Africa. A purposive sample of nursing educational institutions and nursing educators were used. Interviews were conducted with educators (n=9) involved in the teaching of clinical skills in the CNSTC programme and CNSTC newly qualified nurses (n=26) which were selected via snowball sampling. Six themes and eight sub-themes were identified. In the second phase an integrated literature review (ILR) was done, based on the themes from phase one. The results from phase one and two were then synthesised and six strategies were identified as well as possible gaps in the teaching and learning approaches. During phase three of the research the Delphi technique was applied in order to validate the identified strategies and assess the feasibility and applicability of the strategies. Experts in CNSTC (round one n=18, round two n=11) were selected through purposive sampling and requested to rank the strategies in order of importance. The resulted order is firstly, clinical accompaniment and supervision in practice and simulation with, secondly, authentic (real) patients for assessment by students under supervision of educators or facilitators in an environment where students can build self-confidence. The third strategy identified was the holistic, comprehensive management of patients, not only treating a disease. The fourth strategy emphasised the importance of specialised simulation and other equipment for practice and demonstration before students enter clinical practice. The fifth strategy was the importance of making contextual policies and guidelines available and known to students and the final strategy was the use of digital learning material to support student’s learning. The research was evaluated and limitations were discussed. Finally concluding statements were formulated highlighting the contribution of the research towards nursing education and clinical practice and suggestions for subsequent research were made.