Abstract
M.Cur.
Primary clinical nurses (PCNs), traditionally known as primary health care nurses (PHCNs) in South Africa, are expected to function as ‘frontline providers’ of clinical primary health care (PHC) services within the public PHC facilities (Department of Health (DoH), 1996: 8; DoH, 2001a: 23). This extended role of the registered nurse (as set out in section 38A of the Nursing Act, No. 50 of 1978) demands high quality clinical competencies.
The purpose of the study is to describe guidelines to improve clinical competencies of learners within the context of a learning programme PHC: Clinical Nursing, Diagnosis, Treatment and Care (the programme) provided at a specific university in Gauteng where the study was conducted.
The research objectives are to:
o Explore and describe the perceptions of both clinical instructors and learners with regard to reasons for poor clinical competencies of learners of the programme.
o Explore and describe the demographic profile of learners registered at the university in the 2003 academic year for the programme with regard to reasons for poor clinical competencies.
o Explore and describe the correlation between scoring/rating of learners by different clinical evaluators during summative clinical evaluations of learners registered for the programme in the 2003 academic year at the university, in order to ensure inter-rater reliability with regard to reasons for poor clinical competencies.
o Describe guidelines to improve clinical competencies of learners of the programme provided at a university in Gauteng, as informed by the research study findings.
To achieve the purpose and objectives of the study, a mixed methodological design, qualitative and quantitative in nature, was used (Creswell, 1994: 184), utilising the sequential exploratory strategy (Creswell, 2003: 215). Other research strategies used are descriptive and contextual (Creswell, 1994: 145 & 175).
Qualitative data were collected from purposively selected participants in separate focus group interviews of clinical instructors and learners. Analysis was done following Tesch’s method (1990). Trustworthiness was ensured using Lincoln and Guba’s method (1985). Ethical considerations were maintained throughout the study and consent was obtained from the participants.
Quantitative data were collected using a summative clinical evaluation instrument (checklist) administered by clinical evaluators and a self-administered questionnaire for collecting a learner profile from a purposively selected sample of learners and clinical instructors, respectively. Statistics were analysed using a reliable computer program SPSS. Validity and reliability were ensured throughout the study. Data of correlated marks/scores revealed that there was no ecologically significant difference between the marking/scoring of learners by clinical evaluators during summative clinical evaluations of learners.
Qualitative data yielded two main themes from the focus group interviews as challenges that participants perceived as reasons for poor clinical competencies of learners of the programme, viz:
o Challenges within the PHC clinical practice field;
o Challenges within the learning programme (university).
Major categories and subcategories also emerged from the two themes.
Interpretation of both quantitative and qualitative results was integrated and reported as similar findings from which the guidelines to improve clinical competencies of learners of the programme PHC: Clinical Nursing, Diagnosis, Treatment and Care were formulated. The guidelines focused on both the learning programme and the PHC clinical practice field.