Exploring a perceived competency profile for comserve nurses in South Africa
Abstract
Human resource development as a function or sub-function of human resource management plays a vital role in reaching organisation goals by aligning training and development initiatives with organisational strategy. One of the strategic goals of health care organisations, with specific reference to the clinical practice environment, is the delivery of quality patient care. The South African Department of Health also looks upon quality patient care to be a strategic priority to create the quality of life for all South Africans. Clinical practice environments in the public health-care sector are affected by various factors such as staff shortages, poor infrastructure and high workloads. This caused many newly graduated nurses to apply for posts in the private health care sector. In order to guard against this the Minister of Health implemented a compulsory community service year for all nursing graduates also known as comserve ("community service") nurses in the public health care sector. When comserve nurses enter the clinical practice environment they are faced with the challenges of the public health care sector. At the same time they also need to deal with their own challenges such as not being adequately prepared for the new role and feelings of incompetence, theory-practice gaps, poor support and an absence of role-models. All these issues may influence the quality of care delivered by these nurses. The South African Department of Health considers nursing education one of the main challenges to revitalise the nursing profession, as anecdotal evidence indicates that many nurses do not possess adequate competencies in various fields of nursing, which can cause poor-quality care. This problem is intensified by poor communication between clinical practice environments and nursing education institutions. Competence is a combination of knowledge, skills and attitudes needed to perform in specific situations in the clinical practice environment. Human resource development (HRD), in conjunction with relevant stakeholders can assist in addressing this problem by means of a learning needs analysis. A learning needs analysis is used to identify the specific knowledge, skills and attitudes prospective comserve nurses need to be considered competent in the delivery of quality patient care. The identification of learning needs will assist in the development of education, training and development initiatives specifically aimed at delivering quality patient care which is regarded as the main strategic goal of CPEs. The current study formed part of a larger project comprising two separate studies. The intention of the larger project is to conduct a 360-degree learning needs analysis so as to determine the knowledge, skills and attitudes needed by community service nurses to deliver quality patient care. These aspects were only based on perceptions of participants and not on existing nursing education curricula. The current study focussed on the perceptions of nursing educators and final-year nursing students, representing the views of the Nursing Education Institution. The alternative study focussed on the perceptions of nursing managers and community service nurses, representing the perceptions that existed within the clinical practice environment. The larger project will also reflect a perceived competency profile from a 360-degree perspective for community service nurses which can later be compared with existing curricula to determine any educational gaps. The research approach followed in this study was qualitative within a constructivism paradigm using exploratory and descriptive strategies. Semi-structured individual interviews were conducted with (<i>N<i>=42) participants which consisted of (n=23) nurse educators and (n=19) final-year nursing students. Multi-level sampling which consisted of an all-inclusive sampling which was two nursing colleges ((<i>N(<i>=2; n=2) and one university ((<i>N(<i>=2; n=1) and purposive sampling (nurse educators and final-year nursing students) was followed during data collection. A digital recorder was used to capture the data during the interviews and field notes were taken after the interviews. All interviews were transcribed verbatim. The researcher and co-coder applied thematic analysis following a deductive approach in contrast to an inductive approach for analysing and interpreting the data. A deductive approach is a top-down approach for which the researcher already has available predetermined codes based on concepts, ideas or topics for interpreting the data. In this study the predetermined codes were knowledge, skills and attitudes. Phase 1 of the current study explored and described the perceptions held by nurse educators and final-year nursing students regarding the knowledge, skills and attitudes to enable prospective comserve nurses to delivering quality patient care. The results consisted of main themes, sub-themes and sub-sub-themes for both populations. The findings included knowledge, broken down into: theoretical knowledge, practical knowledge, knowledge of holistic care, cultural diversity and code of conduct. Each of these was further broken down into their respective sub-sub-themes. Skills included interpersonal, cognitive, management, administrative, practical and personal skills with their respective sub-sub-themes. Attitudes such as the following were also identified: being caring, positive, humble, compassionate, passionate, friendly, empathetic, sensitive, helpful, life-long learners and walking the extra mile.