The purpose of this study is to gain a richer understanding of the experiences of moral distress for nursing students within the context of psychiatric-mental health clinical placements, examine strategies students use to effectively manage distress, and explore student and instructor roles as agents of change to reduce the negative impact of moral distress. Nursing students and instructors engaged in semi-structured interviews and focus groups, respectively, to examine the complexities of this phenomenon. This study utilized second-person action research based on Jürgen Habermas’ Theory of Communicative Action. Findings indicated that nursing students experience moral distress when they are powerless and lack role models to follow in taking action to address situations that are “not right”. Nursing instructors acknowledge their responsibility to prepare students for practice, but are also powerless as “guests” within the practice setting and are powerless to effect change on a hierarchical medical system. Findings indicate that both nursing education and health care institutions must make changes in their approaches to practice if they wish to empower nursing professionals to provide safe, competent, and ethical care to patients. / vii, 139 leaves ; 29 cm

The intention of this study was to describe the implementation process of the NQF in nursing education at central and provincial levels in order to explore the change process. It deals with this process as follows: Implementation of NQF in nursing education.; Organizational health at central and provincial levels.; The change strategies used at these levels.; The implementation level reached. It is a qualitative study of an enthographic type to describe and document the implementation of the NQF as it occurred. The researcher who was part of the group that generated the culture of learning in nursing, directly participated in the activities and events as they occurred at this initial stage of implementation of the NQF. A discussion between the researcher and nurse educators took place on strategies used and whether they find the existing environment promoting changes. The research techniques used for gathering information were interviews and documents. With this information the researcher was able to reflect, make inferences and interpretations. The state of nursing education was described within the organizational self-renewal strategies described by Owens (1998). The description of the process of implementing the NQF was viewed against the change strategies as described by Bennis, Benne and Chin (1969), which are the empirical rational, normative re-educative and power coercive. The stage of implementation of the NQF in NE that has been achieved has been assessed using the NQF principles as a yardstick. The data collected is largely qualitative and its analysis has been qualitative. The categories of the theoretical framework which are inputs (organizational health); process (change theories); and outcomes (awareness, planning, use and refinement) of the NQF principles, have been used to analyze the data. The findings on organizational health reveal that nursing education is a healthy organization at both central and provincial levels. It has taken the opportunity presented by the NQF to address some of its organizational problems such as the Scope of Practice for nurses and midwives. There are, however, problems in making final decisions about the planned implementation of the NQF because of differences in vision about the future of nursing education. The movement of nursing education (NE) to higher education (HE) is hampering progress because the National Government is not implementing the Education Act No. 101 of 1997 which has moved NE to HE. Both the South African Nursing Council (SANC) and Natal College of Nursing (NCN) have no coherent human resources development policy. At both the central and provincial levels of NE normative re-educative strategies are ones that have been used extensively rather than power coercive strategies. Empirical rational strategies were also made use of to identify the advantages of the NQF policy and to incorporate them into the planned changes. There is full awareness and planning for the implementation of all the principles of the NQF. The principles of the NQF that are already in use and are being refined are integration of education and training, relevance, credibility and legitimacy.This is because they had already been in use in nursing education and practice before the inception of the NQF policy. / Thesis (Ph.D.)-University of Natal, Durban, 2001.

This study was undertaken to explore the extent of cultural sensitivity among the nursing students of Kwa Zulu - Natal Province. A qualitative. ethnographic, explorative design was utilized. A quantitative approach was also used. Subjects were second, third and fourth year students registered for the four year Comprehensive Diploma in Nursing leading to registration as a Nurse (General, Psychiatry, Community Health) and Midwife. To ensure measures of trustworthiness, Guba's model in (Krefting 1991) was implemented. Narrative statements in the form of scenarios and questionnaires were employed to explore, to examine and to describe the extent to which the nursing students are sensitive towards cultures of groups that are different from theirs. The data was analyzed based on the developmental stages of cultural sensitivity by (Bennett 1986). Tesch's method was used to analyze the qualitative data and the Statistical Analysis System (SAS) was used to analyze the quantitative data. Based on the findings. the following conclusions were drawn:- Some students were unable to acknowledge variations that exist among cultures. Problems emanating from cultural differences still exist between nurses and patients due to the ethnocentric views held by some nurses. The study revealed that the students were at varying stages of levels of development of cul tural sensitivity, which means that they ranged from lack of cultural sensitivity to cultural sensitivity. Nursing students, therefore. need more preparation by their program in order to provide culturally congruent nursing care to all. / Thesis (M.Cur.)- University of Natal, Durban, 2000.

A comparative analysis was undertaken using descriptive survey and cross-sectional design to explore the effects of two curricular approaches ( Problem-based learning and traditional) used in Comprehensive basic nursing programme on the development of, clinical reasoning abilities of nursing students was undertaken, Triple Jump Exercise as the data collection instrument was used to evaluate students' abilities, in clinical reasoning, Using quota sampling technique, a convenience sample of 87 subjects was selected from two nursing institutions using these two approaches, These were student nurses in their 1st, 2nd and 4th year levels of study, Using individual interviews, subjects were required to think aloud and verbalize their clinical reasoning after being presented with a clinical scenario, Subjects' verbalizations were quantified, based on the criteria specified in the evaluation form of the data collecting instrument, and total scores were obtained, Analysis using computer software package (SAS) was done to provide for descriptive and statistical summarisation, Though descriptive analysis through mean scores of clinical reasoning showed slight differences resulting from the curricular approaches used. this was not confirmed statistically as the two factor ANOVA and Tukey's method revealed no significant differences by approaches nor their interaction with level of study, Only levels of study had significant differences at p=O,OOO I, with senior levels outperforming their juniors, These findings therefore conclude that PBL and the traditional approach perfonn on a similar level in clinical reasoning. Nurse educators are therefore challenged to identify effective strategies to enhance and nurture clinical reasoning, One strategy, which this study recommends, is the use of case-based approaches in CBNP. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

Up to 1998, the Institutes of Nursing in the United Arab Emirates have been using the traditional lecture-based teaching/learning process in their graduate-nursing program. In 1998, however, these Institutes adopted a new approach; namely, the case-based learning (CBL) for the education of their nursing students. This approach emphasizes the use of self-directed and cooperative learning that is supposed to help students increase their critical thinking (CT) level. As the students were experiencing changes in the teaching practices, it was important to determine the effect of the teaching and learning approaches on students' CT abilities, and to describe suggestions needed for improvement. Empirically, very little is known regarding the influence of CBL on a student's CT. The question then remains, as to whether students who have undergone case-based learning, differ significantly in their CT abilities from those who studied in the traditional method. This study investigates the critical thinking skills in relation to two types of nursing educational programs: (a) the traditional teaching and (b) the case-based learning. The professed purpose of the study in hand is to measure and compare the level of critical thinking in participants from each of the two programs. The instrument of measurement guiding this study is the model developed by Facione and Facione (1998). The design has been a comparative descriptive survey. The critical thinking abilities were measured by the CCTST, which was administered to 38 participants from the traditional curriculum and 65 from the case-based learning curriculum who agreed to participate in the study. When the scores were analyzed by using the independent sample 1- test, this study found that, in general, participants from both programs performed badly on the CCTST. Nevertheless, the CBL program participants performed significantly better when compared to the traditional program participants in all aspects of the CCTST. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

The purpose of this qualitative study was to explore the impact of differentiated instructional techniques on non-traditional, adult student engagement in an RN-BSN completion program course. Differentiated instructional techniques have been a staple method of teaching in K-12 education for a number of years. Differentiated instruction (DI) is a means of teaching students by considering learning preferences and by offering options for meeting course requirements. Non-traditional, adult learners have varied life experiences as well as learning needs. This study addressed how and why engagement of the adult learner in a nursing course was affected by using common differentiated instructional techniques such as model-building, tiered assignment, and literature circles. The study was conducted using case study method. A purposeful sample of non-traditional, adult learners enrolled in an RN-BSN health promotion nursing course was taken. Data were collected via participant observation and field notes, faculty interview, participant journals, open-ended questionnaires, researcher notes, and focus group transcript. Tiered assignments (blog and family assessment) and literature circle postings were also reviewed. Thematic content analysis (TCA) was employed for data analysis. Five major themes emerged from the data: valuing the student, framing, learning environment, non-traditional teaching techniques, and behaviors of engagement. Each major theme was composed of several subthemes. Subthemes associated with valuing the student included personhood, voice of the student, self awareness, choice, and skills related to Gardner’s Multiple Intelligences. The second theme of framing was connected with the subthemes of making meaning and context. The third theme of learning environment entailed subthemes of safety, freedom, structure, and forced engagement. The fourth theme of non-traditional teaching techniques included “Out-of-the-box” thinking, control over learning, and self-directed learning. The final theme of behaviors of engagement was comprised of subthemes of enjoyment, ownership, accountability, motivation, and creativity. Findings of the study indicated that each of the differentiated instructional techniques had a positive impact on student engagement. The subthemes served to identify specific aspects of the DI techniques that were found to be most beneficial for the non-traditional, adult learner. / Department of Educational Studies

Problem-based learning (PBL) is being adopted increasingly as a learning and teaching strategy within the United Kingdom. Although facilitation is recognised as being central to PBL, much of the current literature on facilitation in PBL is conflicting. This study explored the espoused and actual conceptions of PBL adopted by facilitators on a newly-developed pre-registration nursing diploma programme that employed PBL. To explore the lived experience of the PBL curriculum, a constructivist interpretist qualitative research design was adopted. For facilitation in PBL to be effective in promoting independent learning and developing critical thinking, teachers were required to sustain the newly espoused pedagogy and to adapt their actions to match. All participants possessed facilitation skills before the start of the study, however expertise in PBL facilitation took time and practice to acquire as existing skills had to be applied in new ways. Findings identified four broad approaches to facilitation: directive conventionalist, liberating supporter, nurturing socialiser and pragmatic enabler. Over time, most facilitators converged from a directive conventionalist approach towards that of a pragmatic enabler. The transitions were influenced by the need to resolve dissonance between espoused theories and theories-in-use; increased understanding of the dialogic nature of PBL; the use of communicative spaces to share and reflect on experience and an enhanced awareness of student diversity. While the findings relate specifically to PBL facilitation, they also contribute to the understanding of the types of teaching and learning strategies required by the large and increasingly diverse student body.

A quantitative, descriptive research study was conducted at a nursing college to investigate the nature of nursing learners' exposure to computer assisted instruction and computer-based learning, the perceived benefits of this exposure, and the problems that they had encountered. Learners, who had been exposed to computer assisted instruction and computer-based learning, participated. A self-administered, structured questionnaire was administered to collect data. The research results revealed that the learners had limited exposure to educational computer packages, and computer-based learning activities. They encountered numerous problems. Although the learners derived many benefits from computer assisted instruction, this did not result in effective learning. They indicated that they preferred computer assisted instruction more than traditional teaching methods. This study contributed towards recommendations on improving learners' access to the necessary facilities, equipment and educational computer software. The researcher also recommended strategies to ensure that computer assisted instruction is based on sound educational principles. / Health Studies / M.A. (Health Studies)

There is increasing concern that newly qualified registered nurses (RNs) find it difficult to make a smooth transition from completing their four-year nursing training to taking up their posts as first time RNs. In a constantly changing healthcare system, these newly qualified RNs are expected to work independently and be competent in applying the decision making and problem-solving skills gained during their training. While certain aspects of clinical incompetence may be ascribed to individual factors, the importance of the clinical learning environment and its influence on the development of clinical competence cannot be ignored. Nurses need support and guidance to effect a successful transition from being novice to competent nurse and the environment is regarded as important in developing technical competencies. The research study followed a positivistic, quantitative paradigm, where the hypothesized relationship between clinical learning environmental factors and clinical competence of newly qualified RNs were explored. Data was collected from the experienced RNs in the hospitals by means of a structured pre-existing questionnaire, namely the Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and inferential statistics were used to analyse data. The analysed data was used to describe the findings. Recommendations were made based on the findings. Results suggested that the development of clinical competence is dependent on both the individual and context. Positive relations were reported between clinical learning environmental factors and clinical competencies.

The purpose of this study was to establish if, and to what extent, management of nursing colleges enhanced personnel development with regard to the professional and personal development of nurse educators and clinical preceptors. From the literature survey, it was concluded that an effective personnel development programme that included all nursing personnel involved in the education and training of student nurses, was imperative for the rendering of continuous quality nursing education. The importance of co-operation between management of nursing colleges and nursing management of clinical facilities regarding the development of personnel involved in the education and training of student nurses, was emphasised. A programme for personnel development in nursing colleges was developed. The programme included suggestions for the educational development of both nurse educators and clinical preceptors/ registered nurses involved in the education and training of student nurses. It was suggested that nursing colleges should initiate the programme. Research consisted of an in-depth literature review about the management of personnel development in the educational milieu and a survey with regard to the management of the development of personnel involved in the education and training of student nurses. Principals of nursing schools, nursing educators, nursing directors of health services and clinical preceptors in clinical settings formed the population for the study. The theoretical framework used in this research with regard to personnel development in nursing schools, was Donabedian's theory on structural, process and outcomes standards as applied to quality improvement, as well as Alspach's theoretical foundation of nursing staff development. The focus of this study was to use data generated through research to develop a personnel development programme for all registered nurses involved in the education and training of student nurses. The most important conclusions of this research were as follows:  Personnel development was provided for nurse educators and clinical preceptors/ registered nurses involved in the education and training of student nurses in the clinical setting, but it did not necessarily meet the personal and professional developmental needs of these professionals.  The specific developmental needs of nurse educators and clinical preceptors/ registered nurses were related to educational skills, higher cognitive skill and skills related to research.  Available resources at nursing colleges did not facilitate and support the development of nurse educators and clinical preceptors involved in the education and training of student nurses. The main conclusion was that the establishment of a Department of Personnel Development at nursing colleges could provide for the educational needs of both nurse educators and clinical preceptors/ registered nurses, would benefit the personal and professional development of all learners involved and, ulitmately, would enhance the quality of patient care rendered by student nurses. / Advanced Nursing Sciences / D.Litt. et Phil. (Advanced Nursing Sciences)